两种胆囊切除术对≥65岁胆囊结石患者的疗效分析

Effects of two kinds of cholecystectomy on patients≥65 years old with gallstones

目的探讨两种胆囊切除术对≥65岁胆囊结石患者的疗效。方法回顾性抽取2017年12月至2019年12月于郑州市第六人民医院拟行手术治疗的≥65岁胆结石患者100例。根据治疗术式分组,对照组42例行小切口胆囊切除术,观察组58例行腹腔镜胆囊切除术。比较两组患者手术及术后恢复情况、氧化应激指标、肠黏膜屏障功能。结果观察组手术时间、术中出血量、下床活动时间、术后排气时间及住院时间少于对照组(t=4.720、6.196、9.114、8.679、7.292,P<0.05)。术后24 h,两组超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平较术前降低(P<0.05),丙二醛(MDA)水平较术前升高(P<0.05),但观察组术后24 h的SOD、GSH-Ps水平水平高于对照组(t=3.888、5.891,P<0.05),MDA水平低于对照组(t=3.120,P<0.05)。术后3 d,两组患者D-乳酸、内毒素、二胺氧化酶水平较术前升高(P<0.05),但观察组D-乳酸、内毒素低于对照组(t=6.073、2.543,P<0.05)。观察组术后3 d二胺氧化酶水平与对照组比较,t=1.656,P>0.05。结论针对≥65岁胆结石患者行腹腔镜胆囊切除术较小切口胆囊切除术更有利于减少手术创伤,降低患者氧化应激反应,减少手术对肠黏膜屏障功能的损伤。

Objective To investigate the effects of two kinds of cholecystectomy on patients≥65 years old with gallstones.Methods A total of 100 patients≥65 years old with gallstones who were planned to undergo surgical treatment in the Sixth People’s Hospital of Zhengzhou from December 2017 to December 2019 were retrospectively selected,and divided into control group(42 cases,small-incision cholecystectomy)and observation group(58 cases,laparoscopic cholecystectomy)by the treatment methods.The surgery and postoperative recovery,oxidative stress indicators,and mucosal barrier function were compared between the two groups.Results The operative time,the intraoperative blood loss,ambulation time,postoperative exhaust time and hospital stay in observation group were shorter than those in control group(P<0.05).At 24 h after surgery,the levels of superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)in the two groups were significantly reduced(P<0.05),while the level of malondialdehyde(MDA)was increased,but the levels of SOD and GSH-Ps in observation group at 24 h after surgery were significantly higher than those in control group(t=3.888,5.891,P<0.05),while the MDA level was significantly lower than that in control group(t=3.120,P<0.05).At 3 d after surgery,the levels of D-lactic acid,endotoxin and diamine oxidase in the two groups were significantly higher than those before surgery(P<0.05),but the levels of D-lactic acid and endotoxin in observation group at 3 d after surgery were significantly lower than those in control group(t=6.073,2.543,P<0.05),and the level of diamine oxidase was compared between the two groups at 3 d after surgery,(t=1.656,P>0.05).Conclusions Compared with small-incision cholecystectomy,laparoscopic cholecystectomy for patients≥65 years old with gallstones is more conducive to reducing surgical trauma,lowering oxidative stress response,and reducing damage of surgery to intestinal mucosal barrier function.