经脐单孔腹腔镜胆囊切除术对结石性胆囊炎患者肠胃功能恢复、并发症及临床满意度的影响
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摘要
目的探究经脐单孔腹腔镜胆囊切除术(TSHLC)对结石性胆囊炎患者肠胃功能恢复、并发症及临床满意度的影响。方法前瞻性选取2014年3月至2017年8月收治的结石性胆囊炎患者98例,采用随机字母表法分为观察组与对照组。对照组采用常规腹腔镜胆囊切除术治疗,观察组采用TSHLC治疗。观察两组患者手术时间、术中出血量及住院时间,并比较两组炎症因子水平、疼痛评分、肠胃功能恢复情况、并发症发生情况及临床满意度。结果观察组手术时间长于对照组(P<0.05),术中出血量及住院时间与对照组相比差异无统计学意义(P>0.05);观察组VAS评分明显低于对照组,差异有统计学意义(P<0.05),肠鸣音恢复时间、肛门排气时间、排便时间及进食时间均明显短于对照组,差异有统计学意义(P<0.05);两组术后IL-6及hs-CRP水平均显著高于术前,差异有统计学意义(P<0.05),但观察组与对照组相比差异无统计学意义(P>0.05);观察组并发症发生率4.08%低于对照组8.16%,差异无统计学意义(P>0.05);观察组临床满意度显著高于对照组,差异有统计学意义(P<0.05)。结论与常规腹腔镜胆囊切除术相比,TSHLC治疗结石性胆囊炎创伤小,肠胃功能恢复快,疼痛轻,且并发症较少,可显著提高患者临床满意度。
Objective To explore the influence of transumbilical single hole laparoscopic cholecystectomy( TSHLC) on the recovery of gastrointestinal function,complications and clinical satisfaction degree in patients with calculous cholecystitis. Methods Ninety-eight patients with calculous cholecystitis from March 2014 to August 2017 were selected and randomly divided into observation group and control group,the control group was treated with conventional laparoscopic cholecystectomy,and the observation group was treated with TSHLC. The operation time,intraoperative blood loss and hospitalization time of the two groups were observed,and the inflammatory factors levels,pain score,gastrointestinal function recovery,complications and clinical satisfaction degree were compared between the two groups. Results The operation time of the observation group was longer than that of the control group( P < 0. 05),and there had no significant difference in the intraoperative blood loss and hospitalization time between the observation group and the control group( P > 0. 05). The VAS score of the observation group was significantly lower than that of the control group. The difference was statistically significant( P < 0. 05),bowel sound recovery time,anal exhaust time,defecation time and eating time were significantly shorter than those of the control group,the difference was statistically significant( P < 0. 05). The postoperative IL-6 and hs-CRP levels in the two groups were significantly higher than those before operation,the difference was statistically significant( P <0. 05),but there had no significant difference between the observation group and the control group( P > 0. 05). The complication rate of the observation group was 4. 08%,which was lower than that of the control group( 8. 16%),and the difference was not statistically significant( P >0. 05). The clinical satisfaction degree of the observation group was significantly higher than that of the control group,the difference was statistically significant( P < 0. 05). Conclusion TSHLC has less trauma in the treatment of calculous cholecystitis,faster recovery of gastrointestinal function,less pain and fewer complications,and can significantly improve the clinical satisfaction.
Objective To explore the influence of transumbilical single hole laparoscopic cholecystectomy( TSHLC) on the recovery of gastrointestinal function,complications and clinical satisfaction degree in patients with calculous cholecystitis. Methods Ninety-eight patients with calculous cholecystitis from March 2014 to August 2017 were selected and randomly divided into observation group and control group,the control group was treated with conventional laparoscopic cholecystectomy,and the observation group was treated with TSHLC. The operation time,intraoperative blood loss and hospitalization time of the two groups were observed,and the inflammatory factors levels,pain score,gastrointestinal function recovery,complications and clinical satisfaction degree were compared between the two groups. Results The operation time of the observation group was longer than that of the control group( P < 0. 05),and there had no significant difference in the intraoperative blood loss and hospitalization time between the observation group and the control group( P > 0. 05). The VAS score of the observation group was significantly lower than that of the control group. The difference was statistically significant( P < 0. 05),bowel sound recovery time,anal exhaust time,defecation time and eating time were significantly shorter than those of the control group,the difference was statistically significant( P < 0. 05). The postoperative IL-6 and hs-CRP levels in the two groups were significantly higher than those before operation,the difference was statistically significant( P <0. 05),but there had no significant difference between the observation group and the control group( P > 0. 05). The complication rate of the observation group was 4. 08%,which was lower than that of the control group( 8. 16%),and the difference was not statistically significant( P >0. 05). The clinical satisfaction degree of the observation group was significantly higher than that of the control group,the difference was statistically significant( P < 0. 05). Conclusion TSHLC has less trauma in the treatment of calculous cholecystitis,faster recovery of gastrointestinal function,less pain and fewer complications,and can significantly improve the clinical satisfaction.
引文
[1]范宇华.经脐单孔与三孔法腹腔镜胆囊切除术治疗结石性胆囊炎效果比较[J].中国普通外科杂志,2015,24(9):1338-1341.
[2]刘超,张磊.经脐单孔腹腔镜胆囊切除术治疗急性胆囊炎的效果评价[J].临床肝胆病杂志,2015,31(10):1678-1681.
[3]视觉模拟评分法(Visual analogue scale,VAS)[J].临床和实验医学杂志,2013,12(23):1925.
[4]Wang W,Wang C,Qi H,et al.Percutaneous transcystic balloon dilation for common bile duct stone removal in high-surgical-risk patients with acute cholecystitis and co-existing choledocholithiasis[J].HPB(Oxford),2017,13.
[5]饶建.急性结石性胆囊炎腹腔镜胆囊切除手术临床分析[J].临床和实验医学杂志,2010,9(18):1378-1379.
[6]李永利,江奎,朱海林,等.经脐单孔腹腔镜胆囊切除术改良的临床研究[J].中国现代普通外科进展,2015,18(7):526-529.
[7]Luo CY,Ji XX,Zhang J,et al.Operative experiences on transumbilical single incision laparoscopic cholecystectomy[J].Zhonghua Wai Ke Za Zhi,2011,49(5):424-427.
[8]张昊天.经脐单孔腹腔镜胆囊切除术治疗结石性胆囊炎效果观察[J].中国基层医药,2014,21(6):926-927.
[9]李琦,吴海滨.经脐单孔腹腔镜胆囊切除术与传统三孔法腹腔镜胆囊切除术的疗效比较[J].临床肝胆病杂志,2017,33(9):1758-1761.
[10]韩辉.常规器械经脐单孔与三孔腹腔镜胆囊切除术效果比较[J].河南医学研究,2016,25(6):1060-1061.
[11]杨福,何建平,李晓凯.经脐部单孔腹腔镜胆囊切除术及常规腹腔镜胆囊切除术的疗效比较[J].肝胆胰外科杂志,2015,27(6):523-525.
[12]邢惠芝,郭永刚,赵冬雨,等.经脐单孔腹腔镜胆囊切除术32例[J].中国中西医结合外科杂志,2014,20(3):298-299.
[13]姚峰平,柏文庆,顾石,等.经脐单孔腹腔镜胆囊切除术22例[J].中国微创外科杂志,2015,15(5):470-471.
[14]张经中,李晓娟,陈刚,等.经脐单孔与三孔法腹腔镜胆囊切除术的对比研究[J].腹部外科,2014,27(1):621-624.
[15]李瑞斌,李艳茹,万智恒,等.经脐单孔腹腔镜下胆囊切除术的临床可行性研究[J].中国普通外科杂志,2015,24(8):1125-1129.
[16]王梁,贺永刚,李靖,等.经脐单孔腹腔镜胆囊切除术临床应用价值[J].华南国防医学杂志,2015,29(11):876-878.
[2]刘超,张磊.经脐单孔腹腔镜胆囊切除术治疗急性胆囊炎的效果评价[J].临床肝胆病杂志,2015,31(10):1678-1681.
[3]视觉模拟评分法(Visual analogue scale,VAS)[J].临床和实验医学杂志,2013,12(23):1925.
[4]Wang W,Wang C,Qi H,et al.Percutaneous transcystic balloon dilation for common bile duct stone removal in high-surgical-risk patients with acute cholecystitis and co-existing choledocholithiasis[J].HPB(Oxford),2017,13.
[5]饶建.急性结石性胆囊炎腹腔镜胆囊切除手术临床分析[J].临床和实验医学杂志,2010,9(18):1378-1379.
[6]李永利,江奎,朱海林,等.经脐单孔腹腔镜胆囊切除术改良的临床研究[J].中国现代普通外科进展,2015,18(7):526-529.
[7]Luo CY,Ji XX,Zhang J,et al.Operative experiences on transumbilical single incision laparoscopic cholecystectomy[J].Zhonghua Wai Ke Za Zhi,2011,49(5):424-427.
[8]张昊天.经脐单孔腹腔镜胆囊切除术治疗结石性胆囊炎效果观察[J].中国基层医药,2014,21(6):926-927.
[9]李琦,吴海滨.经脐单孔腹腔镜胆囊切除术与传统三孔法腹腔镜胆囊切除术的疗效比较[J].临床肝胆病杂志,2017,33(9):1758-1761.
[10]韩辉.常规器械经脐单孔与三孔腹腔镜胆囊切除术效果比较[J].河南医学研究,2016,25(6):1060-1061.
[11]杨福,何建平,李晓凯.经脐部单孔腹腔镜胆囊切除术及常规腹腔镜胆囊切除术的疗效比较[J].肝胆胰外科杂志,2015,27(6):523-525.
[12]邢惠芝,郭永刚,赵冬雨,等.经脐单孔腹腔镜胆囊切除术32例[J].中国中西医结合外科杂志,2014,20(3):298-299.
[13]姚峰平,柏文庆,顾石,等.经脐单孔腹腔镜胆囊切除术22例[J].中国微创外科杂志,2015,15(5):470-471.
[14]张经中,李晓娟,陈刚,等.经脐单孔与三孔法腹腔镜胆囊切除术的对比研究[J].腹部外科,2014,27(1):621-624.
[15]李瑞斌,李艳茹,万智恒,等.经脐单孔腹腔镜下胆囊切除术的临床可行性研究[J].中国普通外科杂志,2015,24(8):1125-1129.
[16]王梁,贺永刚,李靖,等.经脐单孔腹腔镜胆囊切除术临床应用价值[J].华南国防医学杂志,2015,29(11):876-878.