摘要
目的在胆囊结石伴有高血脂的体检人群中,探讨是否可以通过控制血脂,延缓无症状胆囊结石病情进展,进而降低胆囊结石切除的风险。评估高血脂对胆囊切除术患者术后疼痛的影响情况。方法收集2013年2月-2015年2月于简阳市人民医院常规体检中胆囊结石伴有高血脂的无症状胆囊结石患者153例,随机分为试验组(72例)及对照组(81例)。试验组通过饮食、锻炼及药物等综合控制血脂,3个月时以空腹甘油三酯(TG)及总胆固醇(TC)是否处于正常范围进一步分为血脂达标组(47例)及血脂未达标组(25例)。所有患者随访2年,随访周期为3个月。以胆囊区持续疼痛或近1个月出现3次以上胆囊区不适为腹腔镜胆囊切除手术指征,根据结石数量及大小进行亚组分析,评估胆囊切除发生的风险。同时,采用数字等级疼痛量表评估手术患者住院期间、术后3及6个月的疼痛恢复情况。计量资料2组间比较采用t检验,3组间比较采用单因素方差分析,进一步两两比较采用Bonferroni检验。计数资料组间比较采用χ~2检验。结果 6~24个月血脂控制达标组胆囊切除术发生率(23.4%)较血脂控制不达标组(68.8%)和对照组(70.4%)显著降低(χ~2=27.72,P<0.01)。血脂控制达标组住院期间疼痛评分处于中度疼痛,而未达标组和对照组处于重度疼痛,血脂达标组与2组比较,差异均有统计学意义(P值均<0.05)。对于单发结石、多发结石、≥1 cm结石、<1 cm结石患者,血脂未达标组的胆囊切除率分别为61%(11/18)、86%(6/7)、88%(7/8)和59%(10/17),而血脂达标组中该比例分别为21%(6/29)、28%(5/18)、35%(6/17)和17%(5/30),各类型结石分组中的胆囊切除率比较,差异均有统计学意义(χ~2值分别为7.86、6.87、6.12、8.77,P值均<0.05)。结论在胆囊结石合并有高血脂的患者中,有效控制血脂处于正常值范围可明显减缓疾病进展,进而降低不同类型胆囊结石切除的风险,并且对患者术后疼痛可能具有一定的减弱效应。
Objective To investigate whether blood lipid control can delay the progression of asymptomatic gallstones and reduce the risk of cholecystectomy in patients with gallstones and hyperlipidemia,as well as the influence of hyperlipidemia on postoperative pain after cholecystectomy. Methods A total of 153 patients with asymptomatic gallstones and hyperlipidemia who underwent physical examination from February 2013 to February 2015 were enrolled and randomly divided into experimental group with 72 patients and control group with 81 patients. The patients in the experimental group were given blood lipid control via diet,exercise,and drugs,and according to fasting triglyceride（ TG） and total cholesterol（ TC） after 3 months,these patients were further divided into normal blood lipid group with 47 patients and abnormal blood lipid group with 25 patients. All the patients were followed up for 2 years with an interval of 3 months. The surgical indications for laparoscopic cholecystectomy were persistent pain in the gallbladder or more than 3 times of gallbladder discomfort within the past one month. A subgroup analysis was performed based on the number and size of gallstones to evaluate the risk of cholecystectomy. A numerical pain scale was used to assess the improvement in pain during hospitalization and at 3 and 6 months after surgery. The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between three groups,and the Bonferroni test was used for further comparison between any two groups. The chi-square test was used for comparison of categorical data between groups. Results The normal blood lipid group had a significantly lower rate of cholecystectomy than the abnormal blood lipid group and the control group（ 23. 4% vs 68. 8%/70. 4%,χ2= 27. 72,P 0. 01）. The patients in the normal blood lipid group had moderate pain during hospitalization,while those in the abnormal blood lipid group and the control group had severe pain,and there was a significant difference in pain score between the normal blood lipid group and the abnormal blood lipid group/control group（ P 0. 05）. Among the patients with a single gallstone,multiple gallstones,≥1 cm stones,or 1 cm stones in the abnormal blood lipid group,61%（ 11/18）,86%（ 6/7）,88%（ 7/8）,and 59%（ 10/17） underwent cholecystectomy,while in the normal blood lipid group,21%（ 6/29）,28%（ 5/18）,35%（ 6/17）,and 17%（ 5/30） underwent cholecystectomy,and there were significant differences in the proportion of patients with different types of gallstones who underwent cholecystectomy between the two groups（ χ2= 7. 86,6. 87,6. 12,and 8. 77,all P 0. 05）. Conclusion In patients with gallstones and hyperlipidemia,effective blood lipid control can significantly delay disease progression and reduce the risk of cholecystectomy for different types of gallstones and may alleviate postoperative pain.
出处
《临床肝胆病杂志》
CAS
2017年第10期1961-1965,共5页
Journal of Clinical Hepatology
关键词
高脂血症
胆囊结石病
胆囊切除术
腹腔镜
疼痛
手术后
hyperlipidemias
choleeystolithiasis
cholecystectomy, laparoscopic
pain, postoperative
