两术式联合治疗急性胆囊炎对术后胃肠功能及应激反应指标水平的影响观察  

Observation on effects of combination of two surgical methods on postoperative gastrointestinal function and levels of stress response indicators in the treatment of acute cholecystitis

作　　者：陈海洋 李俊川[1] CHEN Haiyang;LI Junchuan(Department of Surgery,the First People’s Hospital of Ziyang,Ziyang,Sichuan,641300,China)

机构地区：[1]资阳市第一人民医院普外科,四川资阳641300

出　　处：《临床急诊杂志》2021年第7期473-477,共5页Journal of Clinical Emergency

基　　金：四川省医学科研课题(No:S17083)。

摘　　要：目的:探究两术式联合治疗急性胆囊炎(AC)对术后胃肠功能及应激反应指标水平的影响。方法:回顾性分析96例AC患者资料,以手术方案的差异为分组标准分为LC组(腹腔镜胆囊切除术)45例和PTGD+LC组(经皮经肝胆囊穿刺置管引流术^(+)腹腔镜胆囊切除术)51例,比较两组患者手术情况和住院时间、胃肠功能、应激反应指标、炎症和免疫指标、并发症差异。结果:PTGD+LC组患者手术时间、术后住院时间长于LC组(P<0.05),术中出血量少于LC组(P<0.05),两组患者术中中转开腹率差异无统计学意义(P>0.05);PTGD+LC组患者术后肠鸣音恢复时间、肛门排气时间、排便时间及首次耐受固体食物时间均短于LC组(P<0.05);术后72 h内,两组患者促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、皮质醇(Cor)水平先升后降(P<0.05),且PTGD+LC组患者术后24 h、72 h的ACTH、NE、Cor水平低于LC组(P<0.05);术后7 d,两组患者炎症指标[白细胞介素-2(IL-2)、IL-6、超敏C反应蛋白(hs-CRP)]水平升高(P<0.05),免疫指标[T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))]水平降低(P<0.05),但PTGD+LC组患者炎症指标水平低于LC组(P<0.05),免疫指标水平高于LC组(P<0.05);PTGD+LC组患者术后并发症发生率低于LC组(P<0.05)。结论:相较于LC,AC患者行PTGD+LC术式治疗虽延长了手术时间与住院时间,但更有助于促进术后胃肠功能恢复、减轻机体应激反应和炎症反应,免疫抑制更轻,有利于降低并发症风险。Objective: To explore the effects of combination of two surgical methods on postoperative gastrointestinal function and levels of stress response indicators in the treatment of acute cholecystitis(AC). Methods: The data of 96 patients with AC were retrospectively analyzed. The patients were divided into LC group(laparoscopic cholecystectomy, 45 cases) and PTGD+LC group(percutaneous transhepatic gallbladder drainage ^(+) laparoscopic cholecystectomy, 51 cases) based on the differences in surgical methods. The surgical status and hospital stay, gastrointestinal function, stress response indicators, inflammatory indicators and immune indicators and complications were compared between the two groups. Results: The surgical time and postoperative hospital stay in PTGD+LC group were longer than those in LC group(P<0.05), and the amount of intraoperative blood loss was less than that in LC group(P<0.05), and there was no significant difference in the intraoperative conversion rate to laparotomy between the two groups(P>0.05). The postoperative bowel sound recovery time, anal exhaust time, defecation time and first tolerance time of solid food in PTGD+LC group were shorter than those in LC group(P<0.05). Within 72 h after surgery, the levels of adrenocorticotropic hormone(ACTH), norepinephrine(NE), and cortisol(Cor) in the two groups were increased first and then decreased(P<0.05), and the levels of ACTH, NE and Cor in PTGD+LC group were lower than those in LC group at 24 h and 72 h after surgery(P<0.05). At 7 d after surgery, the levels of inflammatory indicators[interleukin-2(IL-2), IL-6, and high-sensitivity C-reactive protein(hs-CRP) ]were increased in the two groups(P<0.05) while the levels of immune indicators[T lymphocyte subsets(CD3^(+), CD4^(+), CD4^(+)/CD8^(+)) ]were decreased(P<0.05), but the levels of inflammatory indicators in PTGD+LC group were lower than those in LC group(P<0.05) while the levels of immune indicators were higher than those in LC group(P<0.05). The incidence rate of postoperative complicatio

关 键 词：联合术式 急性胆囊炎 胃肠功能 应激反应 

分 类 号：R657.4[医药卫生—外科学]