不同手术时机下腹腔镜胆囊切除术对老年患者的影响比较  

Comparison of the Effect of Laparoscopic Cholecystectomy on Elderly Patients with Different Operation Timing

作　　者：刘斌[1] 朱慧 席江伟[1] 郑卫[1] 王新波[1] Liu Bin;Zhu Hui;Xi Jiangwei;Zheng Wei;Wang Xinbo(The Second Affiliated Hospital of Hebei North University,Zhangjiakou 071500)

机构地区：[1]河北北方学院附属第二医院,张家口071500

出　　处：《国际老年医学杂志》2023年第5期579-582,共4页International Journal of Geriatrics

基　　金：河北省卫生健康委科研基金项目(20220578)。

摘　　要：目的 探究不同手术时机下腹腔镜胆囊切除术对老年患者应激反应及肠屏障功能的影响。方法 选取河北北方学院附属第二医院2020年12月~2022年4月收治的120例因急性结石性胆囊炎接受腹腔镜胆囊切除术的老年患者作为研究对象,按照不同手术时间分为A组(发病48 h以内,42例)、B组(发病48~72 h以内,51例)及C组(发病72 h以上,27例)。比较各组术中出血量、术后疼痛程度[采用视觉模拟评分法(VAS)]、术后第1天最高体温、术后止痛药使用情况,手术前后内皮素(ET)、超氧化物歧化酶(SOD)、外周血一氧化氮(NO)水平,手术前后肠屏障功能[尿肠型脂肪酸结合蛋白(IFABP)及血清D-乳酸水平],术前及术后6个月内的胆囊功能(胆囊壁厚度、胆囊收缩率)。结果 各组术后VAS、术后止痛药使用情况比较,差异均有统计学意义(P<0.05);C组术后VAS评分及术后止痛药物使用率高于A组和B组(P<0.05),其中C组术后VAS评分高于B组(P<0.05)。A组治疗前后ET及SOD、NO水平比较,差异均无统计学意义(P>0.05)。B组与C组治疗后ET水平高于治疗前(P<0.05),SOD及NO水平低于治疗前(P<0.05),其中C组ET水平高于B组(P<0.05),SOD、NO水平低于B组(P<0.05)。各组术前及术后尿IFABP、血清D-乳酸比较,差异均无统计学意义(P>0.05)。各组术前及术后6个月胆囊壁厚度及胆囊收缩率比较,差异均无统计学意义(P>0.05)。结论 早期实施腹腔镜胆囊切除术治疗急性结石性胆囊炎的围术期指标表现更好,应激反应较轻,但在术后胆囊功能恢复以及肠屏障功能指标方面并未显示出明显的优势。Objective To investigate the effects of laparoscopic cholecystectomy on stress response and intestinal barrier function in elderly patients at different surgical timing.Methods 120 elderly patients who underwent laparoscopic cholecystectomy for acute calculous cholecystitis at the Second Hospital of Hebei North University from December 2020 to April 2022 were selected as the study subjects,and they were divided into three groups according to different surgical timing:Group A(within 48 hours of onset,42 cases),Group B(within 48-72 hours of onset,51 cases),and Group C(more than 72 hours of onset,27 cases).Intraoperative blood loss,postoperative pain[visual analogue scale(VAS)],maximum body temperature on postoperative day 1,postoperative analgesic use,endothelin(ET),superoxide dismutase(SOD),peripheral blood nitric oxide(NO)levels before and after surgery,intestinal barrier function[urinary intestinal fatty acid binding protein(IFABP)and serum D-lactate levels]before and after surgery,gallbladder function(gallbladder wall thickness,gallbladder contraction rate)before surgery and within 6 months after surgery were compared between the groups.Results There were significant differences in postoperative VAS and postoperative analgesic use among the groups(P<0.05);the postoperative VAS score and postoperative analgesic use rate in group C were higher than those in groups A and B(P<0.05),and the postoperative VAS score in group C was higher than that in group B(P<0.05).There were no significant differences in ET and SOD and NO levels before and after treatment in group A(P>0.05).After treatment,in group B and group C,ET level was higher than that before treatment(P<0.05),SOD and NO levels were lower than those before treatment(P<0.05).In group C,ET level was higher than that in group B(P<0.05),SOD and NO levels were lower than those in group B(P<0.05).There were no significant differences in urinary IFABP and serum D-lactate before and after surgery among the groups(P>0.05).There was no significant difference in gallblad

关 键 词：腹腔镜 胆囊切除术 手术时机 应激反应 胆囊功能 肠屏障功能指标 

分 类 号：R657.4[医药卫生—外科学]