腹腔镜与小切口胆囊切除术在胆结石治疗中的应用  

Application of laparoscopic and small incision cholecystectomy in the treatment of gallstones

作　　者：鲍士远 王恒建[1] 朱丽丹[2] Bao Shiyuan;Wang Hengjian;Zhu Lidan(Department of General Surgery,Hefei First People's Hospital(Shushan Branch),Hefei 230001,Anhui,China;Minimally Invasive Surgery,Hefei First People's Hospital(Shushan Branch),Hefei 230001,Anhui,China)

机构地区：[1]合肥市第一人民医院(蜀山分院)普外科,安徽合肥230001 [2]合肥市第一人民医院(蜀山分院)微创外科,安徽合肥230001

出　　处：《现代科学仪器》2021年第5期142-146,共5页Modern Scientific Instruments

摘　　要：目的:分析腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与小切口胆囊切除术(Minilaparotomy cholecystectomy,MC)对胆结石患者应激反应及术后胃肠功能的影响。方法:将2017年8月~2019年12月拟在本院接受胆囊切除术的120例患者按随机数字表法分LC组、MC组,每组60例。LC组接受腹腔镜胆囊切除术、MC组接受小切口胆囊切除术,比较两组手术情况、应激反应、术后胃肠功能、术后疼痛及并发症发生率。结果:两组住院时间比较差异无统计学意义(P>0.05),但LC组术中出血量显著高于MC组,下床活动时间显著较MC组短,手术时间较MC长,住院费用较MC组高(P<0.05);术后两组应激反应指标较术前显著上升,且LC应激反应指标水平显著低于MC组(P<0.05);LC组肠鸣音恢复时间、术后首次排气时间、肛门排便时间、首次进食固体食物时间均较MC组短(P<0.05);LC组术后1d、术后3d时的视觉模拟疼痛(visual analogue scale,VAS)评分显著低于MC组(P<0.05);但两组并发症发生率比较差异无统计学意义(P>0.05)。结论:较MC,LC具更轻的应激反应,术后胃肠功能恢复更快,值得临床推广。Objective:To analyze the effect of laparoscopic cholecystectomy(LC)and Minilaparotomy cholecystectomy(MC)on stress response and postoperative gastrointestinal function in patients with gallstones.Methods:120 patients who were scheduled to receive cholecystectomy in our hospital from August 2017 to December 2019 were divided into LC group and MC group by random number table method,60 patients in each group.Laparoscopic cholecystectomy was performed in the LC group,and Minilaparotomy cholecystectomy was performed in the MC group.The operation situation,stress response,postoperative gastrointestinal function,postoperative pain and complication rates of the two groups were compared.Results:There was no statistically significant difference in length of stay between the two groups(P>0.05).However,intraoperative blood loss was significantly higher in the LC group than in the MC group,activity time out of bed was significantly shorter than in the MC group,operation time was longer than in the MC group,and hospitalization costs were higher than in the MC group(P<0.05).The stress response index of the two groups increased significantly after operation compared with that before operation,and the level of LC stress response index was significantly lower than that of the MC group(P<0.05).The recovery time of bowel sounds,postoperative first exhaust time,anal defecation time and first solid food intake time in THE LC group were shorter than those in the MC group(P<0.05).Visual analogue pain(VAS)score of LC group was significantly lower than MC group at 1d and 3D after surgery(P<0.05).However,there was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Compared with MC and LC,it has lighter stress response and faster postoperative recovery of gastrointestinal function,which is worthy of clinical promotion.

关 键 词：腹腔镜胆囊切除术 小切口胆囊切除术 胆结石 应激反应 术后胃肠功能 

分 类 号：R604[医药卫生—外科学]