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腹腔镜胆囊切除术治疗急性胆囊炎的效果及预后
Clinical effect of laparoscopic cholecystectomy and prognostic analysis in patients with acute cholecystitis
文章发布日期:2018年01月05日  来源:  作者:席广利,董浩  点击次数:672次  下载次数:94次

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【摘要】:目的探讨腹腔镜胆囊切除术对急性胆囊炎(AC)患者术中、术后恢复情况及术后血清脂多糖(LPS)、淀粉酶(AMY)、促肾上腺皮质激素(ACTH)水平变化的影响。方法选取2015年12月-2017年5月咸阳市中心医院收治的98例AC患者进行回顾性分析,根据不同术式分为观察组(n=49)与对照组(n=49)。对照组行传统开腹胆囊切除术,观察组行腹腔镜胆囊切除术。对比两组术中及术后恢复情况(手术切口长度、手术用时、术中出血量、术后下床活动时间及住院时间)、手术前及术后72 h血清LPS、AMY、ACTH水平、免疫功能[T淋巴细胞亚群(CD3+、CD4+、CD4+/CD8+)]和术后并发症发生率。计量资料两组间比较采用t检验,计数资料两组间比较采用χ2检验。结果与对照组比较,观察组手术切口短、手术用时少、术中出血量低、下床活动及住院时间短(t值分别为26.782、2.950、28.997、11.559、14.678,P值均<0.05),随访1个月后并发症发生率低(8.16% vs 22.45%,χ2=9137,P=0.002);手术前两组血清LPS、AMY、ACTH水平及CD3+、CD4+、CD4+/CD8+比较差异均无统计学意义(P值均>005),术后72 h,观察组LPS、AMY、ACTH明显低于对照组(t值分别为8.762、5.370、3.607,P值均<0.001),CD3+、CD4+、CD4+/CD8+明显高于对照组(t值分别为5.604、6.611、12.025,P值均<0.001)。结论腹腔镜胆囊切除术治疗AC疗效显著,可有效改善血清LPS、AMY水平,且对免疫功能影响相对较小,有利于减轻术后应激反应、降低并发症发生率。
【Abstract】:ObjectiveTo investigate the effect of laparoscopic cholecystectomy on intraoperative and postoperative recovery and changes in serum levels of lipopolysaccharide (LPS), amylase (AMY), and adrenocorticotropic hormone (ACTH) after surgery in patients with acute cholecystitis (AC). MethodsA total of 98 patients with AC who were admitted to Xianyang Central Hospital from December 2015 to May 2017 were enrolled, and according to the surgical procedure, these patients were divided into observation group and control group, with 49 patients in each group. The patients in the control group were given conventional open cholecystectomy, and those in the observation group were given laparoscopic cholecystectomy. The two groups were compared in terms of intraoperative and postoperative recovery (length of surgical incision, time of operation, intraoperative blood loss, time to postoperative ambulation, and length of hospital stay), serum levels of LPS, AMY, and ACTH and immune function [T lymphocyte subsets (CD3+, CD4+, CD4+/CD8+)] before surgery and at 72 hours after surgery, and the incidence rate of complications after surgery. The t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. ResultsCompared with the control group, the observation group had significantly shorter length of surgical incision, time of operation, time to postoperative ambulation, and length of hospital stay, as well as significantly lower intraoperative blood loss (t=26.782, 2.950, 11.559, 14.678, and 28.997, all P<0.05). The incidence of complications decreased during the 1-month follow-up (8.16% vs 22.45%, χ2=9.137, P=0.002). There were no significant differences in the serum levels of LPS, AMY, and ACTH, the percentages of CD3+ and CD4+ T cells, and CD4+/CD8+ ratio between the two groups before surgery (all P>0.05); at 72 hours after surgery, compared with the control group, the observation group had significantly lower serum levels of LPS, AMY, and ACTH (t=8.762, 5.370, and 3.607, all P<0.001) and significantly higher percentages of CD3+ and CD4+ T cells and CD4+/CD8+ ratio (t=5.604, 6.611, and 12.025, all P<0.001). ConclusionLaparoscopic cholecystectomy has a good clinical effect in the treatment of AC and can effectively improve the serum levels of LPS and AMY, with a relatively slight impact on immune function. It helps to reduce postoperative stress response and incidence rate of complications.
【关键字】:胆囊炎, 急性; 胆囊切除术, 腹腔镜; 治疗结果
【Key words】:cholecystitis, acute; cholecystectomy, laparoscopic; treatment outcome
【引证本文】:XI GL, DONG H. Effect of laparoscopic cholecystectomy on intraoperative blood loss and changes in serum levels of lipopolysaccharide, amylase, and adrenocorticotropic hormone after surgery in patients with acute cholecystitis[J]. J Clin Hepatol, 2018, 34(2): 332-336. (in Chinese)
席广利, 董浩. 腹腔镜胆囊切除术治疗急性胆囊炎的效果及预后[J]. 临床肝胆病杂志, 2018, 32(2): 332-336.

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