腹腔镜胆囊切除术治疗慢性胆囊炎伴胆囊结石的临床疗效及安全性分析

Clinical efficacy and safety analysis of laparoscopic cholecystectomy in patients with chronic cholecystitis and cholecystolithiasis

目的 评估腹腔镜胆囊切除术治疗慢性胆囊炎伴胆囊结石对肝功能、炎症因子以及免疫球蛋白的影响.方法 回顾性分析2015年5月-2017年5月丹江口市第一医院收治的慢性胆囊炎伴胆囊结石105例患者的病例资料,根据治疗方式的不同将其分为实验组52例(给予腹腔镜胆囊切除术治疗)和对照组53例(给予传统开腹胆囊切除术治疗),记录手术过程中各项指标、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转氨酶(AST)、总胆红素(TBIL)、γ-谷氨酰转肽酶(GGT)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C-反应蛋白(CRP)、IgA、IgG、IgM并进行比较.正态分布的计量资料用均数±标准差((x)±s)表示,组间比较使用t检验,计数资料比较使用x2检验,两组术后并发症发生率之间比较采用秩和检验,重复测量数据采用重复测量方差分析.结果 实验组手术时间、术中出血量、术后首次排气时间、术后首次排便时间、住院时间、住院费用分别为(73.71±11.62) min、(60.73±6.88) ml、(24.38±3.72)h、(37.21±2.79)h、(5.68±1.78)d、(6 600±1 600)元,对照组分别为(118.48 ±25.52) min、(121.24±13.29) ml、(32.77±4.46)h、(56.85±5.81)h、(9.29±2.89)d、(4900±1 100)元,差异均具有统计学意义(t=3.584、4.183、3.397、3.245、3.489、2.938,均P＜0.05);术后两组患者肝功能指标ALT、AST、TBIL、GGT均显著升高,两组相比差异具有统计学意义(均P＜0.05);术后两组患者炎症因子指标TNF-α、IL-6、IL-8、CRP均显著升高,且术后第1、3、5天实验组TNF-α、IL-6、IL-8、CRP均显著低于对照组,差异具有统计学意义(均P ＜0.05);术后实验组患者免疫球蛋白指标IgA、IgG、IgM与术前相比较差异不明显,差异不具有统计学意义(均P ＞0.05);术后对照组患者免疫球蛋白指标IgA、IgG、IgM与术前相比较均显著降低(均P＜0.05),且术后第1、3、5天对照组IgA、IgG、IgM均显著低于实验组,差异具有统计学意义(均P＜0.05);实验组手术并发症发生率5.77％(3/52)显著低于对照组15.09％ (8/53),差异比较具有统计学意义(Z =5.118,P=0.000).结论 腹腔镜胆囊切除术治疗慢性胆囊炎伴胆囊结石疗效可靠,创伤小、患者住院时间短,术后患者肝功能明显升高但可迅速恢复,患者炎症因子水平改善明显,对免疫功能几乎无影响,且术后并发症发生率低.

Objective To discuss the effect of laparoscopic cholecystectomy open cholecystectomy on liver function,inflammatory factors and immunoglobulin in patients with chronic cholecystitis and cholecystolithiasis.Methods One hundred and five cases of chronic cholecystitis and cholecystolithiasis patients in the First Hospital of Danjiangkou City were selected form May 2015 to May 2017 by taking a retrospective analysis,and divided into experimental group (treated with laparoscopic cholecystectomy,n =52) and control group (treated with traditional open cholecystectomy,n =53) according to the different ways of treatment,recorded and compared the indicators of the operation process,alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBIL),gamma glutamyl transpeptidase (GGT),tumor necrosis factor-u (TNF-α),interleukin-6 (IL-6),interleukin-8 (IL-8),C reactive protein(CRP),IgA,IgG,IgM.The measurement data were expressed by ((x) ± s),and the t test was used comparison between groups,and the x2 test was used comparison between enumeration data,the comparison of the incidence of postoperative complications between the two groups was used the rank sum test,repeated measurement data using repeated measurement variance analysis.Results The operation time,intraoperative blood loss,postoperative anal exhaust time,first defecation time after operation,hospitalization time and hospitalization costs of experimental group were (73.71 ± 11.62) minutes,(60.73 ±6.88) ml,(24.38 ± 3.72) hours,(37.21 ±2.79) hours,(5.68 ±1.78) days,(6600 ±1 600) yuan respectively,the control group were (118.48 ±25.52) minutes,(121.24 ± 13.29) ml,(32.77 ±4.46) hours,(56.85 ±5.81) hours,(9.29 ±2.89) days,(4 900 ± 1 100) yuan respectively,which were statistically significant(the values of t were 3.584,4.183,3.397,3.245,3.489,2.938 respectively,all P ＜ 0.05).The liver function indexes ALT,AST,TBIL and GGT of the two groups were increased significantly after operation,which were statistical difference between the two groups (all P ＜0.05).The inflammatory indexes,TNF-α,IL-6,IL-8,CRP of the two groups were significantly increased,and the 1,3,5 days TNF-α,IL-6,IL-8,CRP after operation of the experimental group were significantly lower than the control group,which were statistical difference (all P ＜ 0.05).Compared with preoperative,the immunoglobulin indexes (IgA,IgG,IgM) of the experimental group after operation were no statistical difference (all P ＞ 0.05).The immunoglobulin indexes IgA,IgG,lgM in the control group were significantly lower than preoperative all P ＜ 0.05,the 1,3,5 days IgA,IgG,IgM of the control group after operation were significantly lower than the experimental group (all P ＜ 0.05).The incidence of operative complications of experimental group 5.77％ (3/52) was significantly lower than the control group 15.09％ (8/53),which was statistical difference (Z =5.118,P =0.000).Conclusion The therapeutic effect of Laparoscopic cholecystectomy on chronic cholecystitis and cholecystolithiasis is reliable,small trauma and short hospitalization time,although patients with postoperative liver function increase significantly but can be quickly restored,the level of inflammatory factors in the patients is significantly improved,and there is little effect on the immune function,and the incidence of postoperative complications is low,so it is worth popularizing in clinical practice.