两种手术方法治疗老年胆囊结石患者的效果研究

Effects of two operation methods in treating elderly patients with gallstone

目的对比双镜结合保胆取石术与腹腔镜胆囊切除术治疗老年胆囊结石患者的效果。方法选取2021年12月至2022年12月该院收治的86例老年胆囊结石患者,按照随机数字表法分为两组,每组43例。给予A组患者腹腔镜胆囊切除术治疗,给予B组患者双镜结合保胆取石术治疗,观察两组手术指标、并发症发生情况、炎症反应指标、胃肠激素水平、疼痛度及应激反应等指标变化情况。结果B组术中出血量少于A组,术后首次排气时间及住院时间显著短于A组,手术时间长于A组,差异均有统计学意义(P<0.05)。B组并发症总发生率较A组更低(P<0.05);术后,B组患者C-反应蛋白、白细胞介素-6、视觉模拟疼痛评分量表评分,以及肾上腺素、皮质醇水平均低于A组(P<0.05),血管活性肠肽与胃蛋白酶原Ⅰ水平高于A组(P<0.05)。结论相较于腹腔镜胆囊切除术,采用双镜结合保胆取石术治疗老年胆囊结石患者,虽手术时间稍长,但其对患者机体组织损伤较少,炎症反应、应激反应较轻,且能保留胆囊生理功能,利于患者术后生活质量的提升。

Objective To compare the effects of double-mirror combination gallbladder-preserving lithotomy and laparoscopic cholecystectomy in treating the elderly patients with gallstone.Methods Eighty-six elderly patients with gallstone treated in this hospital from December 2021 to December 2022 were selected and divided into the two groups by the random number table method,43 cases in each group.The group A was given laparoscopic cholecystectomy and the group B was treated by double-mirror combined with gallbladder-preserving operation.Then the changes of operative indexes,complications occurrence,inflammatory reaction indexes,gastrointestinal hormones levels,pain degree and stress reaction were observed in the two groups.Results The intraoperative blood loss amount in the group B was less than that in the group A,the postoperative first exhausting time and hospitalization duration were significantly shorter than those in the group A,the operative time was longer than that in the group A,and the differences were statistically significant(P<0.05).The total occurrence rate of complications in the group B was significantly lower than that in the group A(P<0.05).The CRP and IL-6 levels,Visual Analogue Pain Rating Scale score,epinephrine and cortisol levels after operation in the group B were lower than those in the group A,and the levels of VIP and PGⅠwere higher than those in the group A(P<0.05).Conclusion Compared with laparoscopic cholecystectomy,although the operation time in the double-mirror combined with gallbladder-preserving lithotomy for treating elderly patients with cholecystolithiasis is a little longer,but the injury to the patients'tissues is less,the inflammatory reaction and stress reaction are mild,moreover the physiological function of gallbladder could be preserved,which is conducive to the improvement of patients'quality of life after operation.