腹腔镜胆囊切除术和开腹手术治疗胆结石的临床效果对比

Comparison of clinical effects of laparoscopic cholecystectomy and open surgery in the treatment of gallstones

目的对比胆结石患者采用腹腔镜胆囊切除术和开腹手术治疗的临床效果。方法60例胆结石患者,按照随机抽签的方式分为观察组和对照组,每组30例。对照组患者接受开腹手术治疗,观察组患者接受腹腔镜胆囊切除术治疗。对比两组患者术后胃肠功能恢复情况[肛门排气时间、肠鸣音恢复时间、进食时间、术后3 d尿乳果糖/甘露醇比值(L/M值)],血清胆红素和总胆红素水平,应激反应指标[血浆皮质醇(Cor)、空腹血糖(FBG)、白细胞计数(WBC)]水平,并发症发生情况。结果观察组患者术后肛门排气时间(15.92±2.36)h、肠鸣音恢复时间(12.45±2.60)h、进食时间(30.61±4.30)h均短于对照组的(18.64±2.65)、(15.94±2.54)、(38.95±4.12)h,术后3 d尿L/M值(0.024±0.006)低于对照组的(0.065±0.009),差异具有统计学意义(P<0.05)。术前,两组患者的血清胆红素和总胆红素水平对比差异无统计学意义(P>0.05);术后第3天,观察组患者的血清胆红素(22.03±4.36)μmol/L和总胆红素(12.68±2.03)μmol/L均低于对照组的(27.69±4.28)、(15.42±2.54)μmol/L,差异具有统计学意义(P<0.05)。术前,两组患者的Cor、FBG、WBC水平对比差异无统计学意义(P>0.05);术后第3天,观察组患者的Cor(217.69±6.30)nmol/L、FBG(5.66±1.03)mmol/L、WBC(7.52±1.22)×109/L均低于对照组的(223.30±8.32)nmol/L、(6.39±1.25)mmol/L、(8.69±1.03)×109/L,差异具有统计学意义(P<0.05)。观察组患者的并发症发生率为3.33%,明显低于对照组的20.00%,差异具有统计学意义(P<0.05)。结论与开腹手术治疗相比,应用腹腔镜胆囊切除术治疗胆结石更有助于改善患者术后胃肠功能恢复情况,缓解患者术后应激反应,且减少并发症发生。

Objective To compare the clinical effects of laparoscopic cholecystectomy and open surgery in the treatment of gallstones.Methods A total of 60 patients with gallstones were divided into observation group and control group according to random lottery method,with 30 cases in each group.Patients in the control group were treated with open surgery,and patients in the observation group were treated with laparoscopic cholecystectomy.Both groups were compared in terms of postoperative recovery of gastrointestinal function[anal exhaust time,recovery time of bowel sounds,eating time,urinary lactose/mannitol(L/M)value on postoperative day 3],serum bilirubin,total bilirubin levels,stress response indexes[plasma cortisol(Cor),fasting blood glucose(FBG),white blood cell count(WBC)]levels,and the occurrence of complications.Results In the observation group,the postoperative anal exhaust time was(15.92±2.36)h,the recovery time of bowel sounds was(12.45±2.60)h,and the eating time was(30.61±4.30)h,which were shorter than(18.64±2.65),(15.94±2.54),and(38.95±4.12)h in the control group;the urinary L/M value at 3 d postoperatively was(0.024±0.006),which was lower than(0.065±0.009)in the control group;the differences were statistically significant(P<0.05).Preoperatively,there was no statistically significant difference between the the two groups in terms of serum bilirubin and total bilirubin levels(P>0.05).On postoperative day 3,the serum bilirubin(22.03±4.36)μmol/L and total bilirubin(12.68±2.03)μmol/L in the observation group were lower than(27.69±4.28)and(15.42±2.54)μmol/L in the control group,and the differences were statistically significant(P<0.05).Preoperatively,there was no statistically significant difference in the comparison of Cor,FBG and WBC levels between the two groups(P>0.05).On postoperative day 3,the Cor(217.69±6.30)nmol/L,FBG(5.66±1.03)mmol/L,and WBC(7.52±1.22)×109/L in the observation group were lower than(223.30±8.32)nmol/L,(6.39±1.25)mmol/L,and(8.69±1.03)×109/L in the control group,and the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 3.33%,which was significantly lower than 20.00%in the control group,and the difference was statistically significant(P<0.05).Conclusion Compared with open surgery,the laparoscopic cholecystectomy for the treatment of gallstones is more helpful in improving patients'postoperative gastrointestinal recovery,relieving their postoperative stress and reducing the occurrence of complications.