60例手术治疗老年胆结石的临床疗效分析

Clinical Analysis of 60 Cases of Surgical Treatment of Senile Gallstones

目的分析和对比不同手术方式治疗老年胆结石的临床疗效。方法方便收集2018年1月—2019年9月在该院治疗的老年胆结石患者60例,并且根据随机数字表法分为对照组(n=30)和研究组(n=30)。对照组患者行传统小切口胆囊切除术治疗,研究组患者行腹腔镜胆囊切除术治疗,对比两组患者术前及术后的丙二醛(MDA)、超氧化物歧化酶(SOD)等应激反应水平、内毒素(LPS)、D-乳酸水平等肠黏膜屏障功能水平,并记录两组患者手术时间、术中出血量、首次下床活动时间、首次排气时间以及住院时间。结果术后,研究组患者SOD水平(93.11±9.36)U/mL显著高于对照组(82.05±8.12)U/mL,研究组患者MDA(5.73±1.04)nmol/mL、LPS(7.83±1.42)ng/L、D-乳酸水平(0.50±0.06)nmol/L等肠黏膜屏障功能水平均显著低于对照组(6.46±1.12)nmol/mL、(9.12±1.74)ng/L、(0.64±0.03)nmol/L(t=9.817、8.192、9.165、8.226,P<0.05)。研究组患者术中出血量(87.15±5.18)mL低于对照组(141.23±9.72)mL,手术时间(94.18±5.27)min、首次下床活动时间(12.05±1.42)h、首次排气时间(28.17±2.23)h以及总住院时间(5.34±0.73)d均短于对照组患者(137.05±9.36)min、(17.28±1.86)h、(35.24±2.31)h、(8.31±1.16)d(t=9.157、8.225、8.194、7.146、9.327,P<0.05)。结论对老年胆结石患者采用腹腔镜胆囊切除术,能减轻患者应激反应程度和肠黏膜屏障损伤,缩短恢复时间。

Objective To analyze and compare the clinical effects of different surgical methods for the treatment of senile gallstones.Methods A total of 60 elderly patients with gallstones treated in our hospital from January 2018 to September 2019 were convenient selected and divided into a control group(n=30)and a research group(n=30)according to the random number table method.The patients in the control group were treated with traditional small incision cholecystectomy,and the patients in the study group were treated with laparoscopic cholecystectomy,comparing the preoperative and postoperative malondialdehyde(MDA),superoxide dismutase(SOD)and other applications level of intestinal mucosal barrier function such as the level of stress response,endotoxin(LPS),D-lactic acid,and the operation time,intraoperative blood loss,time of first out of bed activity,time of first exhaustion,and time of hospitalization were recorded in both groups.Results After surgery,the SOD level of the study group patients(93.11±9.36)U/mL was significantly higher than the control group(82.05±8.12)U/mL,the study group patients MDA(5.73±1.04)nmol/mL,LPS(7.83±1.42)ng/L,D-lactic acid level(0.50±0.06)nmol/L and other intestinal mucosal barrier function levels are significantly lower than the control group(6.46±1.12)nmol/mL,(9.12±1.74)ng/L,(0.64±0.03)nmol/L(t=9.817,8.192,9.165,8.226,P<0.05).The intraoperative blood loss(87.15±5.18)mL of the study group was lower than that of the control group(141.23±9.72)mL,the operation time(94.18±5.27)min,the first time to get out of bed(12.05±1.42)h,and the first exhaust time(28.17±2.23)h and total hospital stay(5.34±0.73)d were shorter than(137.05±9.36)min,(17.28±1.86)h,(35.24±2.31)h,(8.31±1.16)d of the control group,(t=9.157,8.225,8.194,7.146,9.327,P<0.05).Conclusion Laparoscopic cholecystectomy for elderly patients with gallstones can reduce the degree of stress response and intestinal mucosal barrier injury,and shorten the recovery time.