腹腔镜下胆道镜保胆取石术治疗胆囊结石患者的效果  

The Effect of Laparoscopic Cholecystolithotomy in the Treatment of Patients with Gallstones

作　　者：华尚伯[1] 陆贤 顾卯林[1] 班笃敬 Hua Shangbo;Lu Xian;Gu Maolin;Ban Dujing(Kunshan Hospital Affiliated to Nanjing University of Traditional Chinese Medicine,Kunshan Western Medical Center,Kunshan Jiangsu 215300,China)

机构地区：[1]南京中医药大学附属昆山医院·昆山市西部医疗中心,江苏昆山215300

出　　处：《医疗装备》2024年第6期15-18,共4页Medical Equipment

摘　　要：目的探讨腹腔镜下胆道镜保胆取石术(LRCL)治疗胆囊结石患者的效果。方法选取2019年1月至2022年1月医院收治的120例胆囊结石患者,以随机数字表法分为对照组与试验组,每组60例。对照组实施腹腔镜下胆囊切除术(LC),试验组行腹腔镜下LRCL。比较两组取石成功率、术中出血量、手术时间、术后排气时间、住院时间,术前及术后1、3、5 d的疼痛程度[采用数字分级法(NRS)评估],术前、术后5 d的应激反应指标[皮质醇(COR)、肾上腺素(AD)、促肾上腺皮质激素(ACTH)]水平,以及术后并发症发生率。结果两组取石成功率均为100%,无残留结石,无中转开腹。试验组术中出血量少于对照组,手术时间、术后排气时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。术前,两组NRS评分比较,差异无统计学意义(P>0.05);术后1、3、5 d,两组NRS评分均逐渐降低,且试验组各时间点NRS评分均低于对照组,差异有统计学意义(P<0.05)。术前,两组COR、AD、ACTH水平比较,差异均无统计学意义(P>0.05);术后5 d,两组COR、AD、ACTH水平均高于术前,但试验组低于对照组,差异有统计学意义(P<0.05)。试验组术后并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论胆囊结石患者行腹腔镜下LRCL的取石成功率与LC相当,且具有术中出血量少、手术时间短、术后排气快及住院时间短等优势,同时可减轻术后疼痛感,减轻应激反应,降低并发症发生率。Objective To Explore the effectiveness of laparoscopic cholecystolithotomy(LRCL)in the treatment of patients with gallstones.Methods With the selection of 120 patients with gallstones admitted to the hospital from January 2019 to January 2022,they were randomly divided into the control group and the experimental group,by using a random number table method,with 60 cases in each group.The control group underwent laparoscopic cholecystectomy(LC),while the experimental group underwent laparoscopic cholecystolithotomy(LRCL).The success rate of lithotomy,intraoperative blood loss,operative time,postoperative exhaust time,length of hospital stay,and degree of pain before and 1,3,and 5 days after surgery[assessed by numerical rating scale(NRS)],stress response indicators[cortisol(COR),adrenaline(AD),adrenocorticotropic hormone(ACTH)]levels before and 5 days after surgery and the incidence of postoperative complications were compared Between the two groups.Results The success rates of lithotomy in both groups were 100%,with no residual stones and no conversion to open surgery.The amount of blood loss during operation in experimental group was less than that in control group,and the operation time,postoperative exhaust time and hospital stay were all shorter,with statistical significance(P<0.05).Before surgery,there was no statistically significant difference in NRS scores between the two groups(P>0.05);1,3,5 days after surgery,the NRS scores of both groups gradually decreased,and the NRS scores of the experimental group were lower than those of the control group at all time points,with statistical significance(P<0.05).Before surgery,there was no statistically significant difference in the levels of COR,AD,and ACTH between the two groups(P>0.05);After 5 days of surgery,the levels of COR,AD,and ACTH in both groups were higher than before surgery,but the experimental group was lower than the control group,and the difference was statistically significant(P<0.05).The total incidence of postoperative complications in the experi

关 键 词：腹腔镜 胆道镜 保胆取石术 胆囊结石 疼痛程度 应激反应 

分 类 号：R657.42[医药卫生—外科学]