胆囊后三角入路腹腔镜胆囊切除术在急性胆囊炎患者中的应用效果

The Application Effect of Laparoscopic Cholecystectomy with Posterior Cholecystic Triangle Approach in Patients with Acute Cholecystitis

目的探讨胆囊后三角入路腹腔镜胆囊切除术(LC)对急性胆囊炎患者术后肠道功能恢复及生活质量的影响。方法选取2021年1月至2022年5月江西省乐安县人民医院收治的72例急性胆囊炎患者,以随机数字表法分为两组,各36例。对照组实施胆囊前三角入路LC,试验组实施胆囊后三角入路LC。两组术后均进行3个月随访,比较两组各项临床指标。结果与对照组比较,试验组手术时间、肠道功能恢复时间、住院时间均更短,术中出血量更少,术后24 h疼痛程度更低,差异有统计学意义(P<0.05);两组术后1 d血清白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子(TNF-α)水平均高于术前,且试验组低于对照组,差异有统计学意义(P<0.05);两组术后3 d外周血CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均低于术前,试验组高于对照组,差异有统计学意义(P<0.05);两组术后3 d外周血CD8^(+)水平高于术前,试验组低于对照组,差异有统计学意义(P<0.05);两组术后3个月躯体功能、躯体角色、社会功能、情绪角色、精神健康、活力、肢体疼痛、总体健康评分均高于术前,试验组高于对照组,差异有统计学意义(P<0.05);试验组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论在急性胆囊炎患者中应用胆囊后三角入路LC可有效缩短治疗时间,促进肠道功能恢复,降低炎症反应与并发症发生风险,改善免疫功能,提升生活质量。

Objective The effect of laparoscopic cholecystectomy(LC)with posterior cholecystic triangle approach on the postoperative intestinal function recovery and quality of life of patients with acute cholecystitis was evaluated.Methods With selection of 72 patients with acute cholecystitis admitted to the Le'an People's Hospital of Jiangxi Province from January 2021 to May 2022,they were randomly divided into the control group and the observation group,with 36 patients in each group.With implementation of LC with anterior cholecystic triangle approach in the control group,and LC with posterior cholecystic triangle approach in the observation group,both groups were followed up for 3 months,and various clinical indicators were compared between the two groups.Results Compared with the control group,surgery time,the recovery time of intestinal function,and hospitalization time were shorter,the amount of intraoperative bleeding was less,and the pain level at 24 hours after surgery was lower in the observation group,with the statistically significant differences(P<0.05);On the first day after operation,the levels of serum interleukin-6(IL-6),C-reactive protein(CRP),Calcitonin(PCT)and tumor necrosis factor(TNF-α)in the two groups were higher than those before operation,and the levels in the observation group were lower than those in the control group,with the statistically significant differences(P<0.05).On the third day after surgery,the levels of peripheral blood CD3^(+),CD4^(+),CD4^(+)/CD8^(+) in both groups were lower than before surgery,and the observation group was higher than the control group,with the statistically significant differences(P<0.05);On the third day after surgery,the peripheral blood CD8+levels in the two groups were higher than before surgery,while the observation group was lower than the control group,with the statistically significant differences(P<0.05);At 3 months after surgery,physical function,the physical role,social function,emotional role,mental health,vitality,limb pain,and overall health scores of the two groups were higher than those before surgery,and the observation group was higher than the control group,with the statistically significant differences(P<0.05);The total incidence of complications in the observation group was lower than that in the control group,with the statistically significant difference(P<0.05).Conclusion The application of LC with the posterior cholecystic triangle approach in patients with acute cholecystitis can effectively shorten treatment time,promote the recovery of intestinal function,reduce the risk of inflammatory reactions and complications,and improve immune function and quality of life.