腹腔镜逆行次全胆囊切除术治疗急性结石性胆囊炎患者的效果分析

Efficacy analysis of laparoscopic retrograde subtotal cholecystectomy in the treatment of patients with acute lithic cholecystitis

目的:探究腹腔镜逆行次全胆囊切除术治疗急性结石性胆囊炎(ALC)患者的效果及安全性。方法:选取本院97例ALC患者,按照治疗方法的不同分为两组。对照组46例接受腹腔镜逆行胆囊切除术治疗,观察组51例接受腹腔镜逆行次全胆囊切除术治疗,比较两组围术期指标水平(手术时间、术中失血量、术后第1天体温、术后住院时间、腹腔引流量),术前、术后3 d胃肠激素水平[血管活性肠肽(VIP)、胃泌素(GAS)],肝功能[血清天门冬氨酸转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)]和并发症。结果:与对照组比较,观察组手术时间、术后住院时间较短,术中失血量较少(P<0.05),而两组术后第1天体温、腹腔引流量比较差异无统计学意义(P>0.05);术后3 d,两组血清VIP、GAS水平均有所降低,但观察组低于对照组(P<0.05);术后3 d,两组血清AST、ALT、TBIL水平均有所升高,观察组低于对照组(P<0.05);两组并发症比较,观察组低于对照组(P<0.05)。结论:腹腔镜逆行次全胆囊切除术治疗ALC,能优化患者围术期指标水平,减少对胃肠功能、肝功能的影响,且并发症少。

Objective: To investigate the efficacy and safety of laparoscopic retrograde subtotal cholecystectomy in the treatment of patients with acute lithic cholecystitis(ALC). Methods: A total of 97 ALC patients were randomized into 2 groups according to different treatment methods. 46 cases in the control group received laparoscopic retrograde cholecystectomy, while another 51 cases in the observation group received laparoscopic retrograde subtotal cholecystectomy. The perioperative indexes(duration of operation, intraoperative blood loss, postoperative body temperature on the first day after surgery, postoperative hospital stay, and abdominal drainage volume), gastrointestinal hormone levels[vasoactive intestinal peptide(VIP)and gastrin(GAS)], liver functions[serum aspartate transferase(AST), alanine aminotransferase(ALT)and total bilirubin(TBIL)] and complications before and 3 days after surgery were compared between the two groups. Results: Compared with the control group, the duration of operation and postoperative hospital stays were shorter in the observation group, and the amount of intraoperative blood loss was less(P<0.05), and there was no significant difference in the body temperature and abdominal drainage volume between the two groups on the first day after surgery(P>0.05);three days after operation, the levels of serum VIP and GAS in the two groups decreased, but the observation group decreased more than that of the control group(P<0.05);the serum levels of AST, ALT and TBIL in both groups increased, while the observation group increased less than that of the control group(P<0.05). Compared with the control group, the incidence of complications was lower in the observation group(P<0.05). Conclusion: Laparoscopic retrograde subtotal cholecystectomy can optimize the perioperative indexes of ALC patients, reduce the impact on gastrointestinal and liver functions, and has fewer complications.