腹腔镜胆囊切除术在胆结石患者中的临床应用价值

Clinical Application Value of Laparoscopic Cholecystectomy in Patients with Gallstones

目的 探讨腹腔镜胆囊切除术治疗胆结石临床疗效及对炎性细胞因子水平的影响。方法 回顾性纳入本院2016年1月-2022年6月收治的胆结石患者75例,根据医生推荐及患者意愿确定手术方案,其中接受开腹手术治疗23例(对照组),接受腹腔镜胆囊切除术治疗52例(观察组);比较两组治疗总有效率、手术相关临床指标、术后并发症发生率、手术前后血清炎性细胞因子水平。结果 观察组治疗总有效率为96.15%,显著高于对照组的60.87%(P<0.05)。观察组手术时间、手术出血量、术后首次排气时间、术后住院时间及术后24h疼痛视觉模拟评分分别为(55.45±6.29)min、(42.10±6.99)mL、(10.75±1.91)h、(4.33±0.97)d、(3.82±0.99)分,均显著少于对照组的(92.28±10.47)min、(65.03±9.15)mL、(24.87±3.08)h、(12.10±2.65)d、(5.98±1.36)分(P<0.05)。观察组术后并发症发生率为3.85%,显著低于对照组的26.09%(P<0.05)。两组术前超敏C反应蛋白和降钙素原水平比较差异无统计学意义(P>0.05);观察组术后3d超敏C反应蛋白和降钙素原水平均显著低于对照组(P<0.05)。结论 腹腔镜胆囊切除术治疗胆结石可有效减轻临床症状,降低医源性创伤水平,促进术后康复,抑制机体炎症反应水平,且术后并发症发生风险较开腹手术更低。

Objective To investigate the clinical effect of laparoscopic cholecystectomy in the treatment of gallstones and its effect on inflammatory cytokines.Methods A total of 75 patients with gallstones admitted to our hospital from January 2016 to June 2022 were retrospectively included.The surgical plan was determined according to the recommendation of doctors and patients'wishes.23 patients received open surgery(control group)and 52 patients received laparoscopic cholecystectomy(observation group).The total effective rate,surgery-related clinical indicators,postoperative complication rate and serum inflammatory cytokine levels before and after surgery were compared between the two groups.Results The total effective rate of the observation group was 96.15%,significantly higher than that of the control group(60.87%)(P<0.05).Operative time,operative blood loss,first postoperative exhaust time,postoperative hospital stay and 24h postoperative pain visual analog score were(55.45±6.29)min,(42.10±6.99)mL,(10.75±1.91)h,(4.33±0.97)d,(3.82±0.99)points,respectively,which were significantly lower than the control group(92.28±10.47)min,(65.03±9.15)mL,(24.87±3.08)h,(12.10±2.65)d,(5.98±1.36)points(P<0.05).The incidence of postoperative complications in the observation group was 3.85%,significantly lower than that in the control group(26.09%,P<0.05).There was no significant difference in the preoperative levels of hypersensitive C-reactive protein and procalcitonin between the two groups(P>0.05).The average of hypersensitive C-reactive protein and calcitonin raw water in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Laparoscopic cholecystectomy for the treatment of gallstones can effectively reduce clinical symptoms,reduce iatrogenic trauma,promote postoperative rehabilitation,inhibit the level of inflammation,and the risk of postoperative complications is lower than that of open surgery.