摘要
目的探讨腹腔镜胆囊切除术与小切口胆囊切除术对胆囊结石合并胆囊炎患者免疫功能及应激反应的影响。方法选取2016年10月至2019年10月周口市中医院收治的64例胆囊结石合并胆囊炎患者作为研究对象,并按照手术方式将其分为观察组(32例)与对照组(32例),其中观察组患者采用腹腔镜胆囊切除术予以治疗,对照组患者采用小切口胆囊切除术予以治疗,对比两组患者手术时间、术中出血量、肠蠕动恢复时间、住院时间以及手术前后免疫功能相关指标及应激因子水平。结果观察组患者手术时间明显长于对照组(t=2.269,P=0.027),术中出血量明显少于对照组(t=2.915,P=0.005),肠蠕动恢复时间及住院时间明显短于对照组(t=4.454、5.048,P均=0.000);术后1、3、7 d,两组患者CD3^+、CD4^+、CD8^+水平均呈先降低后升高的趋势,且观察组患者CD3^+、CD4^+、CD8^+水平均明显高于对照组(1 d:t=2.116、3.219、3.727,P=0.038、0.002、0.000;3 d:t=2.086、2.355、2.879,P=0.041、0.022、0.006;7 d:t=2.073、2.578、2.049,P=0.042、0.012、0.045);术后1、3、7 d,两组患者白细胞介素-6(IL-6)、C-反应蛋白(CRP)与肿瘤坏死因子-α(TNF-α)水平均呈先升高后降低的趋势,且观察组患者IL-6、CRP与TNF-α水平均明显低于对照组(1 d:t=4.075、3.209、5.907,P=0.000、0.002、0.000;3 d:t=3.509、3.927、2.621,P=0.001、0.000、0.011;7d:t=2.912、2.170、2.333,P=0.005、0.034、0.023)。结论腹腔镜胆囊切除术治疗胆囊结石合并胆囊炎,可有效减少术中出血量、缩短肠蠕动恢复时间及住院时间,降低应激反应,提高免疫功能,临床应用价值较高。
Objective To explore the effect of laparoscopic cholecystectomy and small-incision cholecystectomy on immune function and stress response in patients with gallstones in combination with cholecystitis.Methods Sixty-four patients with gallstones and cholecystitis,admitted to Zhoukou Hospital of Traditional Chinese Medicine from October 2016 to October 2019,were selected as research subjects to be divided,based on the different treatment methods,into an observation group(32 cases)and a control group(32 cases).The patients in the observation group were treated with laparoscopic cholecystectomy while the patients in the control group were treated with small-incision cholecystectomy.Surgery time,intraoperative blood loss,intestinal peristalsis recovery time,duration of hospitalization,immune function related indicators and stress factor levels before and after surgery were compared between the two groups.Results Compared with the control group,the surgery time in the observation group was significantly longer(t=2.269,P=0.027),the intraoperative blood loss was significantly less(t=2.915,P=0.005),and the intestinal peristalsis recovery time and duration of hospitalization were significantly shorter(t=4.454 and 5.048 respectively,both P=0.000).On day 1,3 and 7 after surgery,the levels of CD3^+,CD4^+and CD8^+in the two groups all decreased firstly followed by an increase,and their levels in the observation group were significantly higher than that in the control group(Day 1:t=2.116,3.219 and 3.727 respectively,P=0.038,0.002 and 0.000 respectively;day 3:t=2.086,2.355 and 2.879 respectively,P=0.041,0.022 and 0.006 respectively;day 7:t=2.073,2.578 and 2.049 respectively,P=0.042,0.012 and 0.045 respectively).On day 1,3 and 7 after surgery,the levels of interleukin-6(IL-6),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)in the two groups increased firstly followed by a decrease,and their levels in the observation group were significantly lower than that in the control group(Day 1:t=4.075,3.209 and 5.907 respectively,P=0.000,0.002 and 0.000 respectively;day3:t=3.509,3.927 and 2.621 respectively,P=0.001,0.000 and 0.011 respectively;day 7:t=2.912,2.170 and2.333 respectively,P=0.005,0.034 and 0.023 respectively).Conclusion Laparoscopic cholecystectomy in the treatment of gallstones in combination with cholecystitis can reduce intraoperative blood loss,shorten gastrointestinal peristalsis recovery time and duration of hospitalization,lower stress response and improve immune function,presenting a high value of clinical application.
作者
刘众军
Liu Zhongjun(Department of General Surgery,Zhoukou Hospital of Traditional Chinese Medicine,Zhoukou City,Henan 466000,China)
出处
《中国烧伤创疡杂志》
2020年第4期298-302,共5页
The Chinese Journal of Burns Wounds & Surface Ulcers
关键词
腹腔镜胆囊切除术
小切口胆囊切除术
胆囊结石
胆囊炎
免疫功能
应激反应
Laparoscopic cholecystectomy
Small-incision cholecystectomy
Gallstones
Cholecystitis
Immune function
Stress response
