不同止血方式在急性胆囊炎伴胆囊结石患者腹腔镜胆囊切除术中的应用效果

Comparison on the Application Effect of Different Hemostasis Methods in Laparoscopic Cholecystectomy for Patients with Acute Cholecystitis and Cholecystolithiasis

目的比较不同止血方式在急性胆囊炎(AC)伴胆囊结石患者腹腔镜切除术中的临床效果。方法选取2019年1月至2020年12月遂平县人民医院收治的84例接受腹腔镜胆囊切除术(LC)的AC伴胆囊结石患者作为研究对象。根据止血方法分为A、B组,各42例。A组接受全电凝止血,B组接受局部电凝+生物纸止血。比较两组术后12 h腹腔引流量、术中出血量、术后下床活动时间、住院时间,以及术前、术后24 h肝功能[总胆红素(TBil)、谷丙转氨酶(ALT)、谷草转氨酶(AST)]。比较两组手术结束即刻至出院前并发症发生情况。结果术后12 h,B组腹腔引流量及术中出血量少于A组,术后下床活动时间、住院时间短于A组,差异均有统计学意义(P<0.05)。B组术后24 h TBil、ALT、AST水平低于A组,且A组术后24 h TBil、ALT、AST水平高于术前,差异均有统计学意义(P<0.05);B组术后24 h TBil、ALT、AST水平高于术前,差异无统计学意义(P>0.05)。B组术后并发症总发生率低于A组,差异有统计学意义(P<0.05)。结论相较全电凝止血,局部电凝+生物纸止血效果更好,可有效减少创面出血、渗出,且对患者肝功能损伤较小,可促进康复进程。

Objective To compare the clinical effect of different hemostasis methods in laparoscopic cholecystectomy for patients with acute cholecystitis(AC)and cholecystolithiasis.Methods A retrospective analysis was performed,the clinical data of 84 patients with AC complicated with cholecystolithiasis treated in Suiping County People’s Hospital from January 2019 to December 2020 were collected,all patients underwent laparoscopic cholecystectomy(LC),according to different hemostasis methods,42 patients with total electrocoagulation were included in group A,and 42 patients with local electrocoagulation+bio-paper hemostasis were included in group B.Abdominal drainage volume,intraoperative blood loss,postoperative ambulation time,hospital stay 12 h after operation,and liver function[total bilirubin(TBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST)]before and 24 h after operation were recorded and compared between the two groups,and the complications from immediately at the end of operation to before discharge between the two groups were compared.Results The abdominal drainage amount and intraoperative blood loss amount in group B 12 h after operation were less than those in group A,and the postoperative ambulation time and hospitalization time in group B were shorter than those in group A,with statistical significant differences(P<0.05);the levels of TBil,ALT and AST in group B 24 h after operation were lower than those in group A,and those in group A 24 h after operation were higher than those before operation,with statistical significant differences(P<0.05);the levels of TBil,ALT and AST in group B 24 h after operation were higher than those before operation,there was no statistical significant difference(P>0.05);the total incidence of postoperative complications in group B was lower than that in group A,with a statistical significant difference(P<0.05).Conclusion Compared with total electrocoagulation,local electrocoagulation+bio paper has better hemostatic effect,which can effectively reduce wound bleeding and exudation,and has less damage to liver function,and can promote the rehabilitation process of patients.