腹腔镜与开腹胆囊切除术对老年患者术后应激反应和疲劳综合征影响的对比研究  

The comparative study of the influence of laparoscopic and open cholecystectomy on elderly patients' post-operative stress response and fatigue syndrome

作　　者：张风华[1] 王海久[2] 杨志奇[3] 胡涛[3] 朱振新[3] 

机构地区：[1]青海大学医学院,青海西宁810001 [2]青海大学附属医院 [3]荆州市中心医院

出　　处：《腹腔镜外科杂志》2011年第9期680-684,共5页Journal of Laparoscopic Surgery

摘　　要：目的:对比分析腹腔镜与开腹胆囊切除术对老年患者术后应激反应和术后疲劳综合征的影响,为腹腔镜胆囊切除术治疗胆囊结石的老年患者是否具有优越性提供客观依据。方法:筛选符合适应证的胆囊结石患者40例,随机分为腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)组和开腹胆囊切除术(open cholecystectomy,OC)组,每组20例。分别于术前1天(T0)及术后第1天(T1)、第2天(T2)、第3天(T3)检测患者IL-6、IL-10、C反应蛋白(C reactive protein,CRP)、白细胞(whiteblood cell,WBC)计数、皮质醇及术后疲劳评分指数。对比分析两组手术时间、术中出血量、术后镇痛药使用率、术后发热时间、住院时间等。结果:术后两组患者IL-6均明显升高,T1期达到高峰;T1、T2期LC组IL-6的浓度均低于OC组。IL-10浓度均由T1期开始下降,LC组在T2期达最低;OC组于T3期达最低,T2、T3期LC组明显高于OC组。两组患者CRP水平均于T1期达最高值,OC组术后各期CRP浓度均明显高于LC组,T3期仍明显高于术前。LC组WBC值T1、T2期较术前升高,T3期接近术前水平;OC组术后各期均高于术前,T1期达高峰。术后LC组患者皮质醇浓度均无明显升高,OC组患者T1期升高,与T0期相比差异有统计学意义,T2期开始回落至正常水平;T1期LC组低于OC组。两组患者术后各期的术后疲劳评分均升高,T1期达高峰;组间相比,术后各期OC组均高于LC组。结论:与OC相比,LC治疗老年胆囊结石患者,可明显减少术后应激,减轻老年患者术后疲劳综合征,疗效可靠,具有较高的临床应用价值。Objective：To comparatively analyze the influence of laparoscopic and open cholecystectomy on elderly patients＇ post-operative stress response and fatigue syndrome, trying to offer objective proof for the superiority of laparoscopic cholecystectomy in curing the elderly patients with cholecystolithiasis. Methods：The researcher screened 40 elderly gallbladder calculi patients, and then divided them into 2 operation groups：laparoseopic cholecysteetomy （LC） group and open cholecystectomy （OC） group. Each group consisted of 20 patients. The day before the operation was marked To, the first day after operation was T1, the second day after operation T2,the third day after operation T3. T0,T1 ,T2, T3 were chosen as the observation points. Various indicators, both in pre-operation and post-operation, were examined, such as interleukin-6 （ IL-6 ） , interleukin-10 （ IL-10 ） , C-reactive protein （ CRP ） , white blood cell （WBC）, cortisol and postoperative fatigue score, etc. The operation time, intraoperative blood loss, post-operation analgesic using rate, the post-operative fever time, and the hospital stay were compared and analyzed between the 2 groups. Results：In post-operation, there appeared the obvious IL-6 increase in the two groups. And the increase amounted to the peak in the T1. In the T1 and T2 of post-operation,IL-6 densities in LC were lower than those of OC;In post-operation, the IL-10 density of patients in two groups began to decline both starting from T1. IL-10 densities in LC were at the lowest level in the T2 while in OC they were at the lowest level in the T3. IL-10 density levels measured in the T2 and T3 in LC were significantly higher than those of OC;post-operative CRP levels in both groups reached their peaks in the T1. Meanwhile,in the different post-operative periods CRP density levels in OC were significantly higher than those of LC,besides in the T3 , they were higher than pre-operative level ; the WBC in LC increased in the T1 and T2 ,the level of T3 was simil

关 键 词：胆囊切除术 腹腔镜 剖腹术 应激 术后疲劳综合征 对比研究 

分 类 号：R657.4[医药卫生—外科学]