摘要
目的分析改良式经脐单孔腹腔镜胆囊切除术对患者围术期指标、免疫学指标及术后并发症的影响。方法将我院自2015年1月～2018年2月在我院就诊的60例慢性结石性胆囊炎及胆囊息肉患者按分层随机化法设为观察组(n=30)与对照组(n=30)。观察组行改良式经脐单孔腹腔镜胆囊切除术,对照组行传统腹腔镜胆囊切除术,对比两组一般手术及预后情况,术后不同时间节点的疼痛、围术期白细胞计数(WBC)、C反应蛋白(CRP)及免疫功能指标免疫球蛋白M(Ig M)、CD3+水平。结果两组术中出血量、住院时长、术后24h时疼痛评分比较无统计学意义(P> 0. 05);但观察组手术时长较对照组长,6h时疼痛评分及术后止痛药使用率低于对照组,切口满意度评分高于对照组(均P <0. 05);同时,术后1d时,两组CRP、WBC均上升,较术后1d,术后3d均有下降趋势,但仅组内具统计学意义(P <0. 05);且观察组各时间节点Ig M、CD3+水平比较无统计学意义(P> 0. 05);而对照组组内差异有统计学意义(P <0. 05),但组间比较差异无统计学意义(P> 0. 05)。结论改良式经脐单孔腹腔镜胆囊切除术对术后炎症反应、免疫学指标的影响较传统腹腔镜胆囊切除术小,对机体创伤更小,术后恢复更快,且切口美容效果佳。
Objective To analyze the effect of modified transumbilical single-port laparoscopic cholecystectomy on perioperative indexes, immunological parameters and postoperative complications. Methods 60 patients with chronic calculous cholecystitis and gallbladder polyps who were treated in the hospital from January 2015 to February 2018 were randomly divided into observation group （n = 30） and control group （n = 30）. The observation group were treated by modified transumbilical single-port laparoscopic cholecystectomy, and the control group were treated by conventional laparoscopic cholecystectomy. The general condition of surgery, prognosis, pain at different time points after surgery, perioperative white blood cell count （ WBC）, C-reactive protein （ CRP）, immune function indicators immunoglobulin M （IgM） and CD3 ＋ levels were compared between the two groups. Results There was no significant difference in blood loss, length of hospital stay or pain score at 24 hours after surgery between the two groups （P 〉 0. 05 ）. The surgical time of the observation group was longer than that of the control group, the pain score at 6 hours after surgery and usage rate of analgesics were lower than those in the control group, and the satisfaction score of incision was higher than that in the control group （ all P 〈 0. 05）. The CRP and WBC were increased in both groups at 1 day after surgery, and were higher than those at 3 days after surgery. There were statistically significant differences within the group （P 〈 0. 05）. There was no statistically significant difference in IgM and CD3 ＋ levels in the observation group at different time points （P 〉 0. 05）. There were statistically significant differences within the control group （ P 〈 0.05 ）, but there was no significant difference between the two groups （ P 〉 0. 05 ）. Conclusion Modified umbilical single-port laparoscopic cholecystectomy has less influence on inflammatory reactions and immunological parameters than conventional laparoscopic cholecystectomy. The trauma is less, patients can recover faster after surgery, and the cosmetic effect of incision is better.
作者
李鸥
马论
LI Ou;MA Lun(Department of General Surgery,the Cental Hospital of Bazhong City,Bazhong 636000,China;Outpatient operating room,the Cental Hospital of Bazhong City,Buzhong 636000,China)
出处
《肝胆外科杂志》
2018年第5期356-360,共5页
Journal of Hepatobiliary Surgery
关键词
改良式经脐单孔腹腔镜胆囊切除术
围术期指标
免疫学指标
术后并发症
modified transumbilical single-port laparoscopic cholecystectomy
perioperative parameters
immunological indicators
postoperative complications
