不同手术方式对胆囊结石患者机体应激及炎性状态的影响比较
|
摘要
目的比较不同手术方式对胆囊结石患者机体应激及炎性状态的影响。方法将本院收治的70例胆囊结石患者根据手术方式不同分为传统开腹胆囊切除术组(对照组)和腹腔镜胆囊切除术组(观察组),比较2组患者术中情况、临床疗效、手术前后应激及炎性状态相关指标的变化。结果观察组术中出血量、手术时间、住院时间及排气时间均小于对照组(P<0.05);2组患者术后1 d血糖(BG)、C-反应蛋白(CRP)、血浆皮质醇(Cor)、肾上腺素(E)及血清炎性因子(TNF-α、IL-6、IL-8)均较术前明显上升,其中对照组各指标均高于观察组(P<0.05);术后7 d,2组患者各应激指标及血清炎性因子均较术后1 d明显下降,且观察组各指标明显低于对照组(P<0.05)。结论腹腔镜胆囊切除术能够明显降低患者术中创伤,减轻术后应激及炎症反应,较传统开腹胆囊切除术更为安全有效。
Objective To compare the effects of different surgical methods on the physical stress and inflammatory status in patients with cholecystolithiasis. Methods A total of 70 patients, who underwent cholecystolithiasis in our hospital, were included and divided into traditional open cholecystectomy group(control group) and laparoscopic cholecystectomy group(study group). The changes in the intraoperative conditions, clinical efficacy, stress and inflammatory status related indexes before and after operation were compared between the two groups. Results The blood loss, operation time, length of hospital stay, and time to exhaust in the study group were less than those in the control group(P<0.05). The levels of blood glucose(BG), C-reactive protein(CRP), plasma cortisol(Cor), epinephrine(E), and serum inflammatory factors(TNF-α, IL-6, IL-8) in the two groups at 1 d after operation significantly increased compared with those at the baseline, and the indexes in the control group were higher than those in the study group(P<0.05). The levels of stress indexes and serum inflammatory factors in the two groups significantly decreased at 7 d after operation compared with those at 1 d after operation, and the indexes in the study group were lower than those in the control group(P<0.05). Conclusion Laparoscopic cholecystectomy may significantly reduce intraoperative trauma, and relieve postoperative stress and inflammatory response, which is safer and more effective than traditional open cholecystectomy.
Objective To compare the effects of different surgical methods on the physical stress and inflammatory status in patients with cholecystolithiasis. Methods A total of 70 patients, who underwent cholecystolithiasis in our hospital, were included and divided into traditional open cholecystectomy group(control group) and laparoscopic cholecystectomy group(study group). The changes in the intraoperative conditions, clinical efficacy, stress and inflammatory status related indexes before and after operation were compared between the two groups. Results The blood loss, operation time, length of hospital stay, and time to exhaust in the study group were less than those in the control group(P<0.05). The levels of blood glucose(BG), C-reactive protein(CRP), plasma cortisol(Cor), epinephrine(E), and serum inflammatory factors(TNF-α, IL-6, IL-8) in the two groups at 1 d after operation significantly increased compared with those at the baseline, and the indexes in the control group were higher than those in the study group(P<0.05). The levels of stress indexes and serum inflammatory factors in the two groups significantly decreased at 7 d after operation compared with those at 1 d after operation, and the indexes in the study group were lower than those in the control group(P<0.05). Conclusion Laparoscopic cholecystectomy may significantly reduce intraoperative trauma, and relieve postoperative stress and inflammatory response, which is safer and more effective than traditional open cholecystectomy.
引文
[1]张宏杰.观察腹腔镜胆囊切除术与开腹手术治疗胆结石的临床效果[J].中国实用医刊,2015,42(2):30-31.
[2]孙向宇.胆总管结石合并胆囊结石微创治疗进展[J].中国中西医结合外科杂志,2016,22(3):306-309.
[3] Chang YR,Jin-Young J,Wooil K,et al. Changes in demographic features of gallstone disease:30 years of surgically treated patients[J]. Gut Liver,2013,7(6):719-724.
[4]杨福东.腹腔镜胆囊切除术对老年胆囊结石患者机体应激的影响[J].中国实用医刊,2017,44(3):42-44.
[5]朱杰高,韩威,张忠涛,等.胆囊结石合并胆总管结石的治疗新进展[J].中国全科医学,2013,16(15):1702-1704.
[6] Wu Y,Qin Y,Xu S,et al. Laparoscopic surgery is more advantageous than laparotomic surgery for treatment of hypersplenism with gallstones[J]. Minerva Chirurgica,2015,71(2):80-84.
[7]皮勇,王玲,李晓刚.腹腔镜与开腹胆囊切除术治疗急性胆囊炎的临床效果观察[J/CD].中华普外科手术学杂志:电子版,2015,9(5):39-41.
[8]张国平,吴永,俞炼锋.腹腔镜胆囊切除术对急性结石性胆囊炎患者胃肠功能和应激反应的影响[J].浙江创伤外科,2015,20(4):759-761.
[9]余伦,张钧,焦勇,等.腹腔镜与开腹胆囊切除术对患者肝功能、免疫功能及炎症因子的影响[J].海南医学院学报,2016,22(1):59-61.
[10]余吕连.腹腔镜手术对胆囊结石患者机体应激反应的影响[J].现代诊断与治疗,2017,28(3):478-479.
[11]赵国华.老年胆囊结石患者腹腔镜与开放手术应激反应的比较[J].中国社区医师,2015,31(23):39-40.
[2]孙向宇.胆总管结石合并胆囊结石微创治疗进展[J].中国中西医结合外科杂志,2016,22(3):306-309.
[3] Chang YR,Jin-Young J,Wooil K,et al. Changes in demographic features of gallstone disease:30 years of surgically treated patients[J]. Gut Liver,2013,7(6):719-724.
[4]杨福东.腹腔镜胆囊切除术对老年胆囊结石患者机体应激的影响[J].中国实用医刊,2017,44(3):42-44.
[5]朱杰高,韩威,张忠涛,等.胆囊结石合并胆总管结石的治疗新进展[J].中国全科医学,2013,16(15):1702-1704.
[6] Wu Y,Qin Y,Xu S,et al. Laparoscopic surgery is more advantageous than laparotomic surgery for treatment of hypersplenism with gallstones[J]. Minerva Chirurgica,2015,71(2):80-84.
[7]皮勇,王玲,李晓刚.腹腔镜与开腹胆囊切除术治疗急性胆囊炎的临床效果观察[J/CD].中华普外科手术学杂志:电子版,2015,9(5):39-41.
[8]张国平,吴永,俞炼锋.腹腔镜胆囊切除术对急性结石性胆囊炎患者胃肠功能和应激反应的影响[J].浙江创伤外科,2015,20(4):759-761.
[9]余伦,张钧,焦勇,等.腹腔镜与开腹胆囊切除术对患者肝功能、免疫功能及炎症因子的影响[J].海南医学院学报,2016,22(1):59-61.
[10]余吕连.腹腔镜手术对胆囊结石患者机体应激反应的影响[J].现代诊断与治疗,2017,28(3):478-479.
[11]赵国华.老年胆囊结石患者腹腔镜与开放手术应激反应的比较[J].中国社区医师,2015,31(23):39-40.