开腹及腹腔镜两种术式治疗急性结石型胆囊炎术后肠粘连的临床分析

Clinical Analysis of Two Surgical Methods:Laparotomy and Laparoscopic Treatment of Intestinal Adhesions after Acute Calculous Cholecystitis

目的探讨开腹及腹腔镜两种术式治疗急性结石型胆囊炎对术后肠粘连发生率的影响。方法以2016年7月—2020年4月在该院收治的急性结石型胆囊炎患者60例为研究对象,将患者随机分为对照组和观察组,对照组(n=30)实施开腹手术,观察组(n=30)实施腹腔镜手术,比较两组患者临床疗效。结果观察组术后肠粘连发生率(3.33%)略低于对照组(13.33%),但差异无统计学意义(χ^(2)=0.873,P=0.650)。且观察组术中出血量、肛门排气时间、术后下床活动时间、术后住院时间分别为(25.35±8.30)mL、(22.64±2.93)h、(20.84±2.88)h、(6.20±0.84)d,各项手术相关指标均优于对照组,差异有统计学意义(P<0.05)。观察组手术时间为(63.80±7.25)min,与对照组的(64.83±8.87)min比较差异无统计学意义(t=0.493,P>0.05)。结论相较于开腹胆囊切除术,腹腔镜下胆囊切除术治疗急性结石型胆囊炎患者的术后肠粘连发生率更低,且术中出血少,创伤小,更有利于患者术后恢复,缩短手术后住院时间。

Objective To investigate the influence of laparotomy and laparoscopic treatment of acute calculous cholecystitis on the incidence of postoperative intestinal adhesions.Methods Taking 60 patients with acute calculous cholecystitis admitted in the hospital from July 2016 to April 2020 as the research object,the patients were randomly divided into a control group and an observation group,and the control group(n=30)underwent open surgery.The observation group(n=30)performed laparoscopic surgery,and compared the clinical efficacy of the two groups.Results The incidence of postoperative intestinal adhesions in the observation group(3.33%)was slightly lower than that in the control group(13.33%),but the difference was not statistically significant(χ^(2)=0.873,P=0.650).In the observation group,intraoperative blood loss,anal exhaust time,postoperative time to get out of bed,and postoperative hospital stay were(25.35±8.30)mL,(22.64±2.93)h,(20.84±2.88)h,(6.20±0.84)d,all the operation-related indexes were better than those of the control group,and the difference was statistically significant(P<0.05).The operation time of the observation group was(63.80±7.25)min,which was not significantly different from that of the control group(64.83±8.87)min(t=0.493,P>0.05).Conclusion Compared with open cholecystectomy,laparoscopic cholecystectomy for acute calculous cholecystitis has a lower incidence of postoperative intestinal adhesions,less intraoperative bleeding and less trauma,which is more conducive to postoperative recovery,shortens the hospital stay after surgery.