急性坏疽性胆囊炎腹腔镜微创手术治疗的方法及其疗效探讨

Discussion on the Method and Curative Effect of Laparoscopic Minimally Invasive Surgery for Acute Gangrenous Cholecystitis

目的探讨急性坏疽性胆囊炎腹腔镜微创手术治疗的方法及其疗效。方法通过对2017年12月—2019年12月在该院治疗78例急性坏疽性胆囊炎患者分组,对照组患者应用开腹胆囊切除术治疗,实验组给予腹腔镜胆囊切除术治疗,观察比较两组治疗效果、手术指标、血清指标、术后疼痛、并发症发生率差异。结果实验组总有效率97.44%显著高于对照组,差异有统计学意义(χ^2=7.592,P<0.05);实验组手术时间(71.25±3.29)min、首次排气时间(31.41±3.09)h、引流管拔除时间(2.39±0.62)d、住院时间(7.62±1.25)d较对照组明显缩短,术中出血量(64.27±12.36)mL显著下降,差异有统计学意义(t=4.629、6.381、4.563、5.466、10.517,P<0.05);治疗后实验组中性粒细胞(40.36±2.15)%、白细胞计数(8.39±1.02)×109/L、总胆红素(24.39±3.62)mmol/L同对照组比较显著降低,差异有统计学意义(t=7.536、8.375、6.942,P<0.05);实验组术后1 d VAS评分(4.79±1.23)分、术后3 d(3.35±1.01)分、术后5 d(2.00±0.72)分、术后7 d (1.09±0.43)分较对照组显著降低,差异有统计学意义(t=6.273、5.315、5.209、4.327,P<0.05);实验组并发症发生率12.82%明显低于对照组,差异有统计学意义(χ^2=8.521,P<0.05)。结论针对急性坏疽性胆囊炎患者应用腹腔镜胆囊切除术效果显著,缩短治疗时间,降低术中出血量,改善血清指标,有效缓解疼痛,降低并发症发生率,值得推广应用。

Objective To explore the laparoscopic minimally invasive surgical treatment of acute gangrene cholecystitis and its efficacy.Methods Grouped 78 patients with acute gangrenous cholecystitis treated in the hospital from December 2017 to December 2019.The control group was treated with open cholecystectomy,and the experimental group was treated with laparoscopic cholecystectomy.There were differences in treatment effects,surgical indicators,serum indicators,postoperative pain,and complication rates between the two groups.Results The total effective rate in the experimental group was 97.44%significantly higher than that in the control group,the difference was statistically significant(χ2=7.592,P<0.05);in the experimental group,the operative time(71.25±3.29)min,the first exhaust time(31.41±3.09)h,the drainage tube removal time(2.39±0.62)d,and the hospital stay time(7.62±1.25)d were significantly shorter than those in the control group.The intraoperative blood loss(64.27±12.36)mL was significantly decreased,the difference was statistically significant(t=4.629,6.381,4.563,5.466,10.517,P<0.05).After treatment,neutrophils(40.36±2.15)%,WBC count(8.39±1.02)×109/L,and total bilirubin(24.39±3.62)mmol/L in the experimental group were significantly lower than those in the control group,the difference was statistically significant(t=7.536,8.375,6.942,P<0.05).The postoperative 1 d VAS score(4.79±1.23)points,postoperative 3 d(3.35±1.01)points,postoperative 5 d(2.00±0.72)points and postoperative 7 d(1.09±0.43)points of the experimental group were significantly lower than those of the control group,the difference was statistically significant(t=6.273,5.315,5.209,4.327,P<0.05).The incidence of complications in the experimental group was 12.82%significantly lower than that in the control group,the difference was statistically significant(χ2=8.521,P<0.05).Conclusion Laparoscopic cholecystectomy is effective for patients with acute gangrenous cholecystitis.It shortens the treatment time,reduces intraoperative blood loss,improves serum indicators,effectively relieves pain,and reduces the incidence of complications.It is worth popularizing and applying.