腹腔镜治疗胆囊结石合并急性胆囊炎临床疗效及对免疫功能的影响

Effect of laparoscopic treatment for clinical curative and immune function of patients with gallbladder stone combined with acute cholecystitis

目的探讨腹腔镜和传统开腹手术治疗胆囊结石合并急性胆囊炎的临床疗效及对免疫功能的影响。方法选取平顶山市第一人民医院2016年3月—2017年6月收治的胆囊结石合并急性胆囊炎患者作为研究对象,其中采用腹腔镜治疗的患者48例为腹腔镜组,同期采用传统开腹手术治疗的患者48例为开腹组,对两组患者手术情况、治疗前后的免疫指标及术后3个月的恢复情况进行比较分析。结果腹腔镜组术中出血量(226.54±21.18)mL、切口长度(5.68±0.32)cm、下床活动时间(2.91±0.08)d以及住院时间(11.02±1.18)d,均较开腹组明显减少(P<0.05),而腹腔镜组手术时间(111.15±11.39)min相比开腹组明显延长(P<0.05)。两组术后3d IgA、IgM、IgG及C3水平均较术前明显降低(P<0.05),术后7d恢复至术前水平。组间比较,术后3 d腹腔镜组IgA(189.43±10.34)mg/dl、IgM(149.73±9.16)mg/dl、C3(105.34±6.21)mg/dl水平明显高于开腹组,而IgG水平[(1178.45±34.69)mg/dl]明显低于开腹组[(1197.59±32.81)mg/dl](P<0.05)。腹腔镜组术后切口瘢痕长度[(5.27±0.31)cm]相比开腹组[(10.02±0.35)cm]明显缩短(P<0.05);腹腔镜组术后并发症发生率(4.17%)明显低于开腹组(20.83%)(P<0.05)。结论腹腔镜治疗胆结石合并急性胆囊炎在改善术后免疫功能,提高术后恢复方面具有显著优势。

Objective To study the effect of laparoscopic treatment for clinical curative and immune function of patients with gallbladder stone combined with acute cholecystitis.Methods Selected patients with gallbladder stone combined with acute cholecystitis from March 2016 to June 2017 as the research objects, the 48 cases of patients treated by laparoscopic treatment were laparoscopic group, and 48 cases of patients treated by traditional laparotomy in the same period were laparotomy group, then compared and analyzed the operation situation, immune indexes before and after treatment and recovery situation of postoperative 3 months.Results Intraoperative blood loss(226.54±21.18) mL, incision length(5.68±0.32) cm, ambulation time(2.91±0.08) d, and hospital stay(11.02±1.18) d in the laparoscopic group were significantly reduced compared with the open group(P<0.05), while the operative time(111.15±11.39) min in the laparoscopic group was significantly longer than that of the open group(P<0.05). The levels of 3 dIgA, IgM, IgG and C3 in both groups were significantly lower than those before surgery(P<0.05), and recovered to the preoperative level 7 days after surgery. The levels of IgA(189.43±10.34) mg/dL, IgM(149.73±9.16) mg/dL, and C3(105.34±6.21) mg/dL in the postoperative 3 d laparoscopic group were significantly higher than those of the open group, while the levels of IgG(1178.45±34.69) mg/dL were significantly lower than those of the open group(1197.59±32.81) mg/dL(P<0.05). The length of incision scar(5.27±0.31) cm in the laparoscopic group was significantly shorter than that of the open group(10.02±0.35) cm(P<0.05). The incidence of postoperative complications in the laparoscopic group was significantly lower than that of the open group(4.17%)(P<0.05).Conclusion The laparoscopic treatment in patients with gallbladder stone combined with acute cholecystitis had significant advantage in improving the postoperative immune function and the postoperative recovery.