腹腔镜胆囊切除术治疗胆囊结石合并急性胆囊炎的疗效及对免疫功能和生活质量的影响

Effect of Laparoscopic Cholecystectomy on Cholecystolithiasis Complicated with Acute Cholecystitis and its Effect on Immune Function and Quality of Life

目的:观察腹腔镜胆囊切除术治疗胆囊结石合并急性胆囊炎的疗效及对免疫功能和生活质量的影响。方法:本次研究为回顾性研究,分析2018年3月~2021年3月期间我院收治的98例胆囊结石合并急性胆囊炎患者的临床资料,根据手术方案的不同将患者分为A组(n=46,给予开腹手术)和B组(n=52,给予腹腔镜胆囊切除术),记录两组患者围术期相关指标、肝功能、免疫功能、生活质量和并发症发生率。结果:B组术中出血量少于A组,切口大小短于A组,手术时间长于A组,住院时间、首次排气时间短于A组(P<0.05)。两组术后3 d总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)均升高,但B组低于A组(P<0.05)。B组术后3 d CD3^(+)、CD4^(+)、NK细胞、CD4^(+)/CD8^(+)高于A组(P<0.05),B组术后3 d CD8^(+)低于A组(P<0.05)。B组术后3个月健康生活量表简表(SF-36)各维度评分高于A组(P<0.05)。B组术后并发症发生率虽低于A组,但组间对比差异无统计学意义(P>0.05)。结论:腹腔镜胆囊切除术治疗胆囊结石合并急性胆囊炎,虽然手术时间较开腹手术更长,但切口小、可促进患者术后恢复,对患者免疫功能、肝功能损害更轻,有利于提高患者生活质量。

Objective:To observe the effect of laparoscopic cholecystectomy on cholecystolithiasis complicated with acute cholecystitis and its effect on immune function and quality of life.Methods:This study is a retrospective study.The clinical data of 98 patients with gallstone complicated with acute cholecystitis who were treated in our hospital from March 2018 to March 2021 were analyzed.According to the different operation schemes,the patients were divided into group A(n=46,treated by open operation)and group B(n=52,treated by laparoscopic cholecystectomy).The perioperative related indexes,liver function,immune function,quality of life and incidence of complications.Results:The amount of intraoperative bleeding in group B was less than that in group A,the size of incision was less than that in group A,the operation time was longer than that in group A,and the hospital stay and first exhaust time were shorter than those in group A(P<0.05).The levels of total bilirubin(TBIL),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)at 3d after operation were increased,and the group B were higher than those in group A(P<0.05).CD3^(+),CD4^(+),NK cells and CD4^(+)/CD8^(+)in group B were higher than those in group A(P<0.05),and CD8^(+)in group B was lower than those in group A(P<0.05).The scores of short form of healthy life scale(SF-36)in group B at 3 months after operation were higher than those in group A(P<0.05).Although the incidence of postoperative complications in group B was lower than that in group A,there was no significant difference between groups(P>0.05).Conclusion:Laparoscopic cholecystectomy in the treatment of cholecystolithiasis complicated with acute cholecystitis,although the operation time is longer than that of laparotomy,but the incision is small,can promote the postoperative recovery of patients,has less damage to the immune function and liver function,and is conducive to improving the quality of life of patients.