腹腔镜微创手术对急性胆囊炎患者炎性因子和应激反应的影响

Effects of Laparoscopic minimally invasive Surgery on inflammatory Factors and Stress Response in Patients with acute Cholecystitis

目的观察腹腔镜微创手术对急性胆囊炎患者炎性因子和应激反应的影响。方法回顾性分析2019年7月至2021年7月在嵩县人民医院行手术治疗的62例急性胆囊炎患者的临床资料,根据手术治疗方式的不同分为常规组和研究组,其中常规组患者28例均行传统开腹手术治疗,研究组患者34例均行腹腔镜胆囊切除术治疗,比较两组患者术前和术后3 d炎性因子和应激反应指标水平变化,记录患者术中和术后相关指标水平,评价患者治疗的安全性。结果研究组手术时间、术后排气时间、手术首次下床活动时间和术后住院时长均短于常规组,术中失血量少于常规组,差异有统计学意义(P<0.05)。两组手术前炎症因子水平比较,差异无统计学意义(P>0.05);术后3 d,两组白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)和C反应蛋白(CRP)水平均较术前相比明显升高,差异有统计学意义(P<0.05),但研究组术后3 d的IL-8、TNF-α和CRP水平均低于常规组,差异有统计学意义(P<0.05)。两组手术前应激反应指标水平比较,差异无统计学意义(P>0.05);术后3 d,两组皮质醇(Cor)、去甲肾上腺素(NE)和肾上腺素(E)水平均较术前相比明显升高,差异有统计学意义(P<0.05),但研究组术后3 d的Cor、NE和E水平均低于常规组,差异有统计学意义(P<0.05)。研究组术后并发症发生率5.88%低于常规组32.14%,差异有统计学意义(P<0.05)。结论腹腔镜微创手术治疗急性胆囊炎患者不仅可以减少术中失血量,缩短患者手术时间,还可以在降低并发症发病率的同时减轻机体的炎症反应和应激反应,为患者的预后转归奠定良好的基础,值得应用。

Objective To study the influence of laparoscopy minimally invasive surgery on the inflammatory factors and stress response in patients with acute cholecystitis.Methods The clinical data of 62 patients with acute cholecystitis who underwent surgery in Song County People's Hospital from July 2019 to July 2021 were retrospectively analyzed,they were divided into routine group and study group according to different surgical treatment,28 patients in the routine group were treated with conventional laparotomy,while 34 patients in the study group were treated with laparoscopy cholecystectomy.The levels of inflammatory factors and stress response indexes were compared between the two groups before and 3 days after operation,the levels of relevant indexes during and after operation were recorded and the safety of treatment was evaluated.Results The operation time,postoperative exhaust time,initial ambulant time and hospitalization time in the study group were shorter than routine group;the intraoperative bleeding volume was less than that in the routine group(P<0.05).There was no significant difference in the levels of inflammatory factors between the two groups before operation(P>0.05),the levels of interleukin-8(IL-8),tumor necrosis factorα(TNF-α)and C-reactive protein(CRP)in the two groups were significantly higher 3 days after operation than those before operation(P<0.05),but the levels of IL-8,TNF-αand CRP in the study group were significantly lower than those in the routine group 3 days after operation(P<0.05).There was no significant difference in the levels of stress response indexes between the two groups before operation(P>0.05),the levels of cortisol(Cor),norepinephrine(NE)and epinephrine(E)in the two groups were significantly higher 3 days after operation than those before operation(P<0.05),the levels of Cor,NE and E in the study group were significantly lower than those in the routine group 3 days after operation(P<0.05).The incidence of postoperative complications in the study group(5.88%)was significantly lower than that in the routine group(32.14%,P<0.05).Conclusion Laparoscopic minimally invasive surgery for acute cholecystitis can not only reduce the intraoperative bleeding volume and shorten the operative time,but also reduce the inflammatory reaction and stress reaction of the body while reducing the incidence of complications,to lay a good foundation for the prognosis of patients,it is worth applying.