急性结石性胆囊炎患者应用腹腔镜胆囊切除术治疗的疗效及并发症研究

Study on the curative effect and complications of laparoscopic cholecystectomy in patients with acute calculous cholecystitis

目的探究腹腔镜胆囊切除术治疗急性结石性胆囊炎的效果及术后并发症发生情况。方法74例急性结石性胆囊炎患者,随机划分为对照组与研究组,各37例。对照组患者使用常规开腹手术治疗,研究组患者使用腹腔镜胆囊切除术治疗。比较两组患者炎症因子水平、手术情况、生活质量、术后恢复指标、并发症发生率。结果术后,研究组患者肿瘤坏死因子(TNF-α)(45.78±4.01)pg/ml、C反应蛋白(CRP)(16.69±1.64)mg/L、白细胞介素(IL)-6(55.78±5.01)pg/ml明显比对照组的(51.91±4.74)pg/ml、(19.63±1.51)mg/L、(61.63±5.16)pg/ml更低,差异有统计学价值(P<0.05)。研究组患者手术时间(50.22±4.47)min、腹痛缓解时间(3.20±0.28)d、引流管拔除时间(2.41±0.25)d均短于对照组的(57.91±4.92)min、(4.13±0.50)d、(3.46±0.49)d,术中出血量(26.21±2.33)ml少于对照组的(37.73±3.14)ml,差异有统计学价值(P<0.05)。研究组患者心理、生理、社会、环境评分分别为(88.57±6.13)、(87.28±6.35)、(90.81±4.58)、(91.25±4.49)分,比对照组的(80.05±6.21)、(79.48±6.36)、(83.04±5.63)、(85.19±5.42)分高,差异有统计学价值(P<0.05)。研究组肠鸣音恢复时间(12.19±2.08)h、首次肛门排气时间(16.57±3.56)h、首次进食时间(26.41±5.68)h、住院时间(5.36±1.29)d均短于对照组的(15.98±3.49)h、(20.23±3.82)h、(31.06±5.32)h、(9.67±3.25)d,差异有统计学价值(P<0.05)。研究组并发症发生率2.70%低于对照组的18.92%,差异有统计学价值(P<0.05)。结论在急性结石性胆囊炎治疗中,使用腹腔镜胆囊切除术可有效改善患者病情,且术后并发症更少、炎症水平更低,有利于提升患者生活质量。

Objective To explore the effect and complications of laparoscopic cholecystectomy in the treatment of acute calculous cholecystitis.Methods 74 patients with acute calculous cholecystitis were randomly divided into a control group and a study group,with 37 cases in each group.Patients in the control group were treated with conventional laparotomy,and those in the study group were treated with laparoscopic cholecystectomy.The levels of inflammatory factors,operation status,quality of life,postoperative recovery index and complication rate were compared between the two groups.Results After the surgery,the tumor necrosis factor-α(TNF-α)of the study group was(45.78±4.01)pg/ml,the C-reactive protein(CRP)was(16.69±1.64)mg/L,and the interleukin-6 was(55.78±5.01)pg/ml,which were significantly lower than(51.91±4.74)pg/ml,(19.63±1.51)mg/L,and(61.63±5.16)pg/ml in the control group,and the difference was statistically significant(P<0.05).In the study group,the operation time was(50.22±4.47)min,the time of abdominal pain relief was(3.20±0.28)d,and the time of drainage tube removal was(2.41±0.25)d,which were shorter than(57.91±4.92)min,(4.13±0.50)d,and(3.46±0.49)d in the control group;the intraoperative blood loss of(26.21±2.33)ml in the study group was less than(37.73±3.14)ml in the control group;the difference was statistically significant(P<0.05).The psychological,physical,social,and environmental scores of patients in the study group were(88.57±6.13),(87.28±6.35),(90.81±4.58)and(91.25±4.49)points,which were higher than(80.05±6.21),(79.48±6.36),(83.04±5.63)and(85.19±5.42)points in the control group,and the difference was statistically significant(P<0.05).In the study group,the recovery time of bowel sounds was(12.19±2.08)h,the time of first anal defecation was(16.57±3.56)h,the time of first feeding was(26.41±5.68)h,and the time of hospitalization was(5.36±1.29)d,which were shorter than(15.98±3.49)h,(20.23±3.82)h,(31.06±5.32)h,and(9.67±3.25)d in the control group,and the difference was statistically significant(P<0.05).The complication rate of 2.70%in the study group was lower than 18.92%in the control group,and the difference was statistically valuable(P<0.05).Conclusion In the treatment of acute calculous cholecystitis,laparoscopic cholecystectomy can effectively improve the condition of patients,and there are fewer postoperative complications and lower levels of inflammation,which is conducive to improving the patient's quality of life.