不同腹腔镜手术入路方式对老年急性胆囊炎患者应激激素、并发症和预后的影响  

Influence of different laparoscopic surgical approaches on stress hormones,complications,and prognosis in elderly patients with acute cholecystitis

作　　者：姚远[1] 樊文良 王洋 褚青波[1] YAO Yuan;FAN Wen-liang;WANG Yang;CHU Qing-bo(Department of Emergency Surgery,Nanyang Second People's Hospital,Nanyang 473000,Henan,CHINA)

机构地区：[1]南阳市第二人民医院急诊外科,河南南阳473000

出　　处：《海南医学》2024年第6期794-798,共5页Hainan Medical Journal

基　　金：河南省科技攻关项目(编号:222102311464)。

摘　　要：目的探讨不同腹腔镜手术入路方式对老年急性胆囊炎患者应激激素、并发症和预后的影响。方法回顾性分析2020年1月至2022年11月南阳市第二人民医院收治的157例经手术治疗的老年急性胆囊炎患者的临床资料,根据腹腔镜手术入路方式不同分为侧方组(n=79)和顺/逆行组(n=78),侧方组患者行侧方入路剥离胆囊,顺/逆行组患者行顺/逆行剥离胆囊。比较两组患者的围术期指标,以及手术前后的应激激素[血管紧张素Ⅱ(AngⅡ)、促生长激素(GH)、皮质醇(Cor)]、胆管损伤指标[乳果糖与甘露醇比值(L/M)、尿脂肪酸结合蛋白(IFABP)]和肠屏障功能指标[碱性磷酸酶(ALP)、直接胆红素(DBIL)],同时比较两组患者的并发症和预后情况。结果侧方组和顺/逆行组患者的术中出血量[(27.71±3.38)mL vs(56.63±4.87)mL]、术后引流量[(18.89±2.11)mL vs(70.26±5.34)mL]比较,侧方组明显少于顺/逆行组,住院时间[(4.01±0.38)d vs(4.95±0.43)d]和术后引流置管时间[(2.71±0.35)d vs(3.51±0.41)d]比较,侧方组明显短于顺/逆行组,差异均有统计学意义(P<0.05);术前至术后72 h,两组患者的血清GH、Cor、AngⅡ呈升高-降低趋势,且术后24 h,侧方组患者的血清GH、Cor、AngⅡ明显低于顺/逆行组,差异均有统计学意义(P<0.05);术前至术后72 h,两组患者的尿L/M、IFABP呈升高-降低趋势,且术后24 h,侧方组患者的血清DBIL、ALP水平明显低于顺/逆行组,差异均有统计学意义(P<0.05);侧方组患者的并发症发生率为3.80%,明显低于顺/逆行组的15.38%,差异有统计学意义(P<0.05);术后3个月后门诊随访,侧方组患者的预后优良率为75.95%,明显高于顺/逆行组的60.26%,差异有统计学意义(P<0.05)。结论老年急性胆囊炎腹腔镜手术术中选择侧方入路、顺/逆行剥离胆囊效果确切,但侧方入路并发症少、预后效果良好,且能降低患者术后应激激素水平。Objective To investigate the effects of different laparoscopic surgical approaches on stress hormones,complications,and prognosis in elderly patients with acute cholecystitis.Methods A total of 157 elderly patients with acute cholecystitis in Nanyang Second People's Hospital from January 2020 to November 2022 were selected and divided into lateral group(n=79)and anterograde/retrograde group(n=78)according to laparoscopic surgical approach.The lateral approach was used for gallbladder dissection in the lateral group,and anterograde/retrograde gallbladdoider dissection was used in the anterograde/retrograde group.The perioperative indexes,stress hormones[angiotensinⅡ(AngⅡ),growth stimulating hormone(GH),cortisol(Cor)],bile duct injury indexes[ratio of ltose to mannitol(L/M),urinary fatty acid binding protein(IFABP)],intestinal barrier function indexes[alkaline phosphatase(ALP),direct bilirubin(DBIL)],pathogenesis,prognosis were compared between the two groups.Results The lateral group had less intraoperative blood loss[(27.71±3.38)mL vs(56.63±4.87)mL],less postoperative drainage[(18.89±2.11)mL vs(70.26±5.34)mL],a shorter length of hospital stay[(4.01±0.38)d vs(4.95±0.43)d],and a shorter postoperative drainage tube placement time[(2.71±0.35)d vs(3.51±0.41)d]than the retrograde/antegrade group,with statistically significant differences(P<0.05).From preoperative to postoperative 72 hours,the serum GH,Cor,and AngⅡlevels in both groups of patients showed an increasing-decreasing trend,and the lateral group had significantly lower serum GH,Cor,and AngⅡlevels than the retrograde/antegrade group at 24 hours after surgery,with statistically significant differences(P<0.05).From preoperative to postoperative 72 hours,the urine L/M and IFABP levels in both groups showed an increasing-decreasing trend(P<0.05).The lateral group had significantly lower serum DBIL and ALP levels than the retrograde/antegrade group at 24 hours after after surgery(P<0.05).The lateral group had a significantly lower complication rate

关 键 词：急性胆囊炎 腹腔镜手术 入路选择 应激激素 并发症 预后 

分 类 号：R657.41[医药卫生—外科学]