腹腔镜胆囊切除术对胆结石的临床疗效研究

Study on the clinical effect of laparoscopic cholecystectomy on gallstones

目的探讨腹腔镜胆囊切除术对胆结石患者的临床疗效,分析其对血清炎症因子、免疫功能及肠黏膜损伤程度的影响。方法选取2019年12月至2021年2月五华县明鑫医院收治的80例胆结石患者为研究对象进行前瞻性研究,采用随机数字表法分为研究组40例和对照组40例,分析两组患者围手术期指标、血清炎症因子和免疫功能、术后3个月Chiu's评分、GLQI量表评分变化以及不良反应的发生情况。结果研究组患者的围术期指标均优于对照组(P<0.05)。治疗后,研究组患者C-反应蛋白(CRP)(18.50±2.60)mg/L低于对照组(30.14±3.20)mg/L、白细胞介素-6(IL-6)(31.22±2.68)pg/L低于对照组(45.17±3.26)pg/L、肿瘤坏死因子-α(TNF-α)(119.43±35.42)μg/L低于对照组(158.36±38.75)μg/L;CD3+(64.41±6.33)U/L高于对照组(58.50±10.4)U/L、CD4+(35.77±3.90)U/L高于对照组(25.55±4.70)U/L、免疫球蛋白A(IgA)(1.90±0.19)g/L高于对照组(1.66±0.22)g/L、免疫球蛋白G(IgG)(11.01±1.42)g/L高于对照组(10.12±1.33)g/L(P<0.05)。研究组患者Chiu's分级分别是Ⅰ级19例、Ⅱ级14例、Ⅲ级5例、Ⅳ~Ⅴ级2例,对照组Chiu`s分级分别是Ⅰ级8例、Ⅱ级10例、Ⅲ级17例、Ⅳ~Ⅴ级5例,差异有统计学意义(P<0.05)。研究组患者的消化病生存质量指数(GLQI)量表评分为(113.26±15.0)分,高于对照组的(98.40±21.9)分(P<0.05)。研究组患者不良事件总发生率为2.5%,低于对照组的20%(P<0.05)。结论腹腔镜胆囊切除术治疗胆结石的临床效果更好,可以有效减少炎症的发生,改善免疫功能和减少肠黏膜损伤,提高患者生活质量。

Objective To explore the clinical effect of laparoscopic cholecystectomy on patients with gallstones,and analyze its influence on serum inflammatory factors,immune function and the degree of intestinal mucosal injury.Methods A prospective study was conducted on 80 patients with gallstones admitted to Mingxin Hospital in Wuhua County from December 2019 to February 2021.They were divided into a study group of 40 cases and a control group of 40 cases according to a random number table.The perioperative indicators,serum inflammatory factors and immune function,Chiu's score,GLQI scale score changes and the occurrence of adverse reactions were analyzed in the two groups after 3 months.Results The perioperative indexes of the study group were better than those of the control group(P<0.05).After treatment,the study group's CRP(18.50±2.60)mg/L was lower than the control group(30.14±3.20)mg/L,and IL-6(31.22±2.68)pg/L was lower than the control group(45.17±3.26)pg/L,TNF-α(119.43±35.42)μg/L is lower than the control group(158.36±38.75)μg/L;CD3+(64.41±6.33)U/L is higher than the control group(58.50±10.4)U/L,CD4+(35.77±3.90)U/L is higher than the control group(25.55±4.70)U/L,IgA(1.90±0.19)g/L is higher than the control group(1.66±0.22)g/L,IgG(11.01±1.42)g/L It was higher than the control group(10.12±1.33)g/L(P<0.05).The Chiu's classification of the study group was 19 cases of gradeⅠ,14 cases of gradeⅡ,5 cases of gradeⅢ,and 2 cases of gradeⅣ~Ⅴ.The Chiu's classification of control group was 8 cases of gradeⅠ,10 cases of gradeⅡ,and gradeⅢ.There were 17 cases,5 cases from grade IV to V,the difference was statistically significant(P<0.05).The GLQI scale score of the study group was(113.26±15.0)points,which was higher than the(98.40±21.9)points of the control group(P<0.05).The total incidence of adverse events in the study group was 2.5%,which was lower than 20%in the control group(P<0.05).Conclusion Laparoscopic cholecystectomy has a better clinical effect in the treatment of gallstones.It can effectively reduce the occurrence of inflammation,improve immune function and reduce intestinal mucosal damage,and improve the quality of life.