腹腔镜胆囊切除术治疗急性胆囊炎患者64 例临床分析

doi:10.3877/cma.j.issn.1674-0793.2015.02.013

目的

探讨腹腔镜胆囊切除术对急性胆囊炎患者的临床疗效和应用价值。

方法

选取2012 年3 月至2014 年6 月就诊的急性胆囊炎患者128 例,采用抽签随机取样法将其分为开腹组(行开腹胆囊切除术)和腹腔镜组(行腹腔镜胆囊切除术),各64 例。比较两组患者各项临床指标以及术后切口感染、腹腔感染等并发症发生率,手术前后T 细胞亚群、免疫球蛋白及C 反应蛋白(CRP)的差异。

结果

腹腔镜组患者手术时间等术中指标及肛门排气时间等术后各项指标等均显著低于开腹组(P＜0.05)。术前两组患者T 细胞亚群、免疫球蛋白及CRP 比较差异均无统计学意义,术后腹腔镜组患者各指标均与手术前相接近,开腹组显著低于术前(P＜0.05),且显著低于腹腔镜组(P＜0.05)。腹腔镜组中转开腹手术3 例(4.69%),除切口感染发生率低于开腹组外,其余并发症发生率均高于开腹组,但差异均无统计学意义。

结论

腹腔镜胆囊切除术创伤小,减轻了因开腹及长时间禁食造成的痛苦,大大缩短了住院时间,降低手术造成的机体炎性应激反应程度,且安全性较高,在操作经验丰富、严格把握适应证条件下,值得推广应用。

关键词: 腹腔镜胆囊切除术, 开腹胆囊切除术, 急性胆囊炎

Objective

To study the clinical efficacy of laparoscopic cholecystectomy for acute cholecystitis.

Methods

One hundred and twenty-eight cases with acute cholecystitis were selected from March 2012 to June 2014. They were randomly divided into laparotomy group (64 cases, underwent open cholecystectomy) and laparoscopic group (64 cases, underwent laparoscopic cholecystectomy). Clinical data such as indicators, infection of incision, incidence of complications were compared between the two groups.T cell subsets, immunoglobulin and C-reactive protein (CRP) before and after surgery were also analyzed.

Results

For laparoscopic group, the operation time, anus exhaust time, postoperative indicators were significantly lower than those of laparotomy group (P ＜0.05). Before surgery, there was no statistical significance between the two groups on T cell subsets, immunoglobulin and CRP. For laparoscopic group, the indexes before and after operation were near (P＜0.05). The postoperative level in laparotomy group was significantly lower than preoperative level (P＜0.05), and significantly lower than that of laparoscopic group(P＜0.05). Three patients (4.69%) were transferred to laparotomy in laparoscopic group; the complications incidence was higher than that of laparotomy group, but there was no statistical difference.

Conclusions

Laparoscopic cholecystectomy has less injuries, reducing pains caused by the cut-open and long time fasting, greatly shortening the length of hospital stay, and reducing the the body's inflammatory stress response caused by surgery. It is safe after rich operating experiences and worthy of application with strict indications.

Key words: Laparoscopic cholecystectomy, Open cholecystectomy, Acute cholecystitis

表1 两组患者术中及术后恢复情况比较(,t 检验)

组别	例数	手术时间(min)	术中出血量(ml)	卧床时间(d)	肛门排气时间(d)	肠蠕动恢复时间(h)	住院时间(d)
开腹组	64	60.53±19.64	89.45±22.31	3.82±0.42	2.96±0.42	18.53±2.64	7.96±1.86
腹腔镜组	64	40.26±17.54	40.28±19.58	2.94±0.28	1.84±0.33	30.42±4.26	5.02±1.53
t值		6.158	13.252	13.947	16.775	18.980	9.766
P值		0.001	0.000	0.000	0.000	0.000	0.000

表1 两组患者术中及术后恢复情况比较(,t 检验)

组别	例数	手术时间(min)	术中出血量(ml)	卧床时间(d)	肛门排气时间(d)	肠蠕动恢复时间(h)	住院时间(d)
开腹组	64	60.53±19.64	89.45±22.31	3.82±0.42	2.96±0.42	18.53±2.64	7.96±1.86
腹腔镜组	64	40.26±17.54	40.28±19.58	2.94±0.28	1.84±0.33	30.42±4.26	5.02±1.53
t值		6.158	13.252	13.947	16.775	18.980	9.766
P值		0.001	0.000	0.000	0.000	0.000	0.000

表2 两组患者手术前后T 细胞亚群、Ig 及CRP 差异比较()

组别	CD3(%)	CD4(%)	CD8(%)	IgA(g/L)	IgG(g/L)	IgM(g/L)	CRP(mg/L)
开腹组(64例)
治疗前	60.47±3.99	32.94±2.17	28.65±1.83	2.85±0.32	11.85±0.92	1.65±0.23	7.25±0.95
治疗后	52.53±3.34	27.86±1.96	26.41±1.69	1.24±0.11	9.58±0.71	0.79±0.06	7.31±1.02
腹腔镜组(64例)
治疗前	60.59±3.87	32.71±2.43	28.51±1.94	2.78±0.36	11.78±0.95	1.66±0.20	11.94±2.97
治疗后	59.22±3.26	30.53±2.08	27.92±1.81	2.69±0.28	11.69±0.82	1.54±0.17	9.87±3.02
t ₁,t₂值	0.093,8.712	0.806,7.456	0.759,2.384	0.109,3.260	0.297,13.562	0.268,6.307	0.344,5.148
P ₁,P₂值	0.995,0.002	0.238,0.003	0.264,0.021	0.878,0.013	0.591,0.000	0.713,0.004	0.366,0.006

表2 两组患者手术前后T 细胞亚群、Ig 及CRP 差异比较()

组别	CD3(%)	CD4(%)	CD8(%)	IgA(g/L)	IgG(g/L)	IgM(g/L)	CRP(mg/L)
开腹组(64例)
治疗前	60.47±3.99	32.94±2.17	28.65±1.83	2.85±0.32	11.85±0.92	1.65±0.23	7.25±0.95
治疗后	52.53±3.34	27.86±1.96	26.41±1.69	1.24±0.11	9.58±0.71	0.79±0.06	7.31±1.02
腹腔镜组(64例)
治疗前	60.59±3.87	32.71±2.43	28.51±1.94	2.78±0.36	11.78±0.95	1.66±0.20	11.94±2.97
治疗后	59.22±3.26	30.53±2.08	27.92±1.81	2.69±0.28	11.69±0.82	1.54±0.17	9.87±3.02
t ₁,t₂值	0.093,8.712	0.806,7.456	0.759,2.384	0.109,3.260	0.297,13.562	0.268,6.307	0.344,5.148
P ₁,P₂值	0.995,0.002	0.238,0.003	0.264,0.021	0.878,0.013	0.591,0.000	0.713,0.004	0.366,0.006

表3 两组患者并发症发生情况比较[例(%)]

组别	例数	切口感染	腹腔感染	胆道损伤	胆瘘
开腹组	64	4(6.25)	1(1.56)	2(3.13)	1(1.56)
腹腔镜组	64	1(1.56)	2(3.13)	4(6.25)	3(4.69)
χ ²值		1.873	0.341	0.699	1.032
P值		0.365	1.000	0.680	0.619

表3 两组患者并发症发生情况比较[例(%)]

组别	例数	切口感染	腹腔感染	胆道损伤	胆瘘
开腹组	64	4(6.25)	1(1.56)	2(3.13)	1(1.56)
腹腔镜组	64	1(1.56)	2(3.13)	4(6.25)	3(4.69)
χ ²值		1.873	0.341	0.699	1.032
P值		0.365	1.000	0.680	0.619

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Curative effect of laparoscopic cholecystectomy for 64 patients with acute cholecystitis

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Curative effect of laparoscopic cholecystectomy for 64 patients with acute cholecystitis