腹腔镜胆囊切除术与小切口胆囊切除术治疗胆结石的临床效果及对应激反应的影响

目的:探讨腹腔镜胆囊切除术与小切口胆囊切除术治疗胆结石的临床效果及对应激反应的影响。方法:选取2016年1月至2016年12月于我院行胆囊切除术治疗的胆结石患者80例作为研究对象,根据治疗方案不同将研究对象分为腹腔镜组和小切口组,腹腔镜组采用腹腔镜胆囊切除术,小切口组采用小切口胆囊切除术,比较两组患者手术时间、术中出血量、肛门排气时间、住院时间以及术后并发症的发生情况,检测并比较两组患者术前、术后1d、3d的白细胞(WBC)计数、中性粒细胞(NE)百分数、空腹血糖(Glu)、血清皮质醇(Cor)含量、C-反应蛋白(CRP)含量。结果:腹腔镜组的手术时间、术中出血量、肛门排气时间、住院时间均明显短于小切口组(P0.05),并发症发生率显著低于小切口组(P0.05)。术前,两组的WBC、NE、Glu、Cor、CRP水平比较差异均无统计学意义(P0.05);腹腔镜组术后1 d的WBC、NE、Glu、Cor、CRP水平均显著高于术前(P0.05),术后3 d的Glu、Cor、CRP恢复至术前水平(P0.05),WBC、NE也有所降低但仍高于术前(P0.05);小切口组术后1 d的WBC、NE、Glu、Cor、CRP水平均显著高于术前(P0.05),且高于同期腹腔镜组(P0.05),术后3 d的WBC、NE、Glu、Cor、CRP水平有所降低但仍高于术前(P0.05),且高于同期腹腔镜组(P0.05)。结论:腹腔镜胆囊切除术引起的应激反应更轻,并有利于胆结石患者术后快速恢复,并减少并发症的发生。

Clinical Efficacy of Laparoscopic Cholecystectomy and Small Incision Cholecystectomy in the Treatment of Cholelithiasis and Effect on the Stress Response

ABSTRACT Objective: To investigate the clinical efficacy of laparoscopic cholecystectomy and small incision cholecystectomy in the treatment of cholelithiasis and effect on the stress response. Methods: 80 patients with cholelithiasis treated in our hospital from January 2016 to December 2016 were selected and divided into two groups: laparoscopic group and small incision group. The operation time, intraoperative blood loss, anal exhaust time, hospital stay and postoperative complications were compared between the two groups, the WBC, NE %, the fasting blood glucose (Glu), serum cortisol (Cor) and C- reactive protein (CRP) levels were measured and compared between the two groups before and on the 1st, 3rd after operation. Results: The operation time, bleeding volume, anal exhaust time, hospitalization time in the laparoscopic group were shorter than those in the small incision group(P<0.05), the complication rate of laparoscopic group was lower than that of small incision group(P<0.05). Before operation, there was no significant difference in the WBC, NE, Glu, Cor and CRP levels between the laparoscopic group and the small incision group (P>0.05); the levels of WBC, NE, Glu, Cor and CRP in the laparoscopic group were significantly higher on the 1st day after operation than those before operation (P<0.05), the Glu, Cor and CRP recovered to preoperative level on the 3rd day after operation (P>0.05), the WBC and NE were also decreased but still higher than those preoperation (P<0.05); the WBC, NE, Glu, Cor, CRP levels on the 1st day after operation in the small incision group were significantly higher than those before operation (P<0.05), which were higher than those in the laparoscopic group (P<0.05). The levels of WBC, NE, Glu, Cor and CRP decreased on the 3rd day after operation, but they were still higher than those before operation (P<0.05), which were higher than those of the laparoscopic group (P<0.05). Conclusion: The stress response caused by laparoscopic cholecystectomy is lighter, which is beneficial to the rapid recovery of patients after operation and reduce the incidence of complications.