侧方入路腹腔镜胆囊切除治疗急性胆囊炎并胆囊结石的效果及术后恢复质量观察  

Effectiveness of laparoscopic cholecystectomy in the treatment of acute cholecystitis with gallbladder stones by lateral approach and quality of postoperative recovery

作　　者：杨江波 蔡红 曾繁利[3] YANG Jiang-Bo;CAI Hong;ZENG Fan-li(Department of General Surgery,The Second Hospital of Qinhuangdao,Qinhuangdao Hebei 066600,China;Department of Hand-foot Surgery,The Second Hospital of Qinhuangdao,Qinhuangdao Hebei 066600,China;Department of Hepatobiliary Surgery,The Second Hospital of Qinhuangdao,Qinhuangdao Hebei 066600,China)

机构地区：[1]秦皇岛市第二医院普通外科,河北秦皇岛066600 [2]秦皇岛市第二医院手足外科,河北秦皇岛066600 [3]秦皇岛市第二医院肝胆外科,河北秦皇岛066600

出　　处：《临床和实验医学杂志》2025年第4期389-393,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省卫生健康委员会资助课题(编号:20200458)。

摘　　要：目的观察侧方入路腹腔镜胆囊切除治疗急性胆囊炎并胆囊结石的效果及术后恢复质量。方法前瞻性选取2020年4月至2023年6月秦皇岛市第二医院收治的154例急性胆囊炎并胆囊结石患者,按照随机数字表法将其分为顺/逆行组(n=77)和侧方组(n=77)。顺/逆行组采用顺/逆行剥离腹腔镜胆囊切除术,侧方组采用侧方入路剥离腹腔镜胆囊切除术。比较两组手术一般情况(手术时间、术中出血量、首次排气时间、术后下床活动时间、引流管留置时间、住院时间、手术成功情况),评估两组术后12、24、48 h的疼痛[视觉模拟评分法(VAS)评分]变化,记录两组术前及术后1、3 d的手术应激反应指标[皮质醇、C反应蛋白(CRP)、促肾上腺皮质激素(ACTH)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)]水平及术后并发症发生情况。结果侧方组与顺/逆行组的手术时间、首次排气时间、术后下床活动时间、手术成功率比较,差异均无统计学意义(P>0.05);侧方组的术中出血量为(31.04±7.11)mL,少于顺/逆行组[(52.45±8.95)mL],引流管留置时间与住院时间分别为(2.74±0.81)、(4.78±0.96)d,均短于顺/逆行组[(3.66±1.02)、(5.65±1.14)d],差异均有统计学意义(P<0.05)。侧方组术后12 h的VAS评分为(1.65±0.41)分,低于顺/逆行组[(1.77±0.36)分],差异有统计学意义(P<0.05);两组术后24、48 h的VAS评分比较,差异均无统计学意义(P>0.05)。术后1、3 d,两组的皮质醇、CRP、ACTH、TNF-α、IL-8水平均较术前升高,但侧方组术后1、3 d的皮质醇、CRP、ACTH、TNF-α、IL-8水平均低于顺/逆行组,差异均有统计学意义(P<0.05)。侧方组术后总计并发症发生率与顺/逆行组比较,差异无统计学意义(P>0.05)。结论侧方入路腹腔镜胆囊切除治疗急性胆囊炎并胆囊结石的出血量少,引流时间短,并发症发生率低,对机体应激创伤较顺/逆行入路更小。Objective To observe the effect of laparoscopic cholecystectomy by lateral approach in the treatment of acute cholecystitis with gallbladder stones and the quality of postoperative recovery.Methods A total of 154 patients with acute cholecystitis and gallbladder stones admitted to The Second Hospital of Qinhuangdao from April 2020 to June 2023 were prospectively selected and divided into the cis/retrograde group(n=77)and the lateral group(n=77)according to the random number table method.The cis/retrograde group was operated by cis/retrograde stripping laparoscopic cholecystectomy,and the lateral group was operated by stripping laparoscopic cholecystectomy with lateral approach.The general surgical conditions(the operation time,intraoperative blood loss,first exhaust time,postoperative ambulation time,drainage tube indwelling time,hospitalization time,success rate of operation)of two groups were compared,and changes in visual analogue of pain(VAS)scores were assessed at 12,24,and 48 h after operation,and surgical stress indicators[cortisol,C-reactive protein(CRP),adrenocorticotropic hormone(ACTH),tumour necrosis factor-alpha(TNF-alpha),and interleukin-8(IL-8)]before operation,1 d,and 3 d after operation,and the occurrence of postoperative complications were recorded in the two groups.Results There were no statistically 0x09significant differences in the operation time,the first exhaust time,the time of getting out of bed after operation and the success rate of operation between the lateral group and the cis/retrograde group(P>0.05).The intraoperative blood loss in the lateral group was(31.04±7.11)mL,which was less than that in the cis/retrograde group[(52.45±8.95)mL],the drainage tube indwelling time and hospitalization time were(2.74±0.81)and(4.78±0.96)d,respectively,which were shorter than those in the cis/retrograde group[(3.66±1.02)and(5.65±1.14)d],and the differences were statistically significant(P<0.05).The VAS score at 12 h after operation in the lateral group was(1.65±0.41)points,which was lower th

关 键 词：急性胆囊炎 腹腔镜胆囊切除 胆囊结石病 侧方入路 顺/逆行入路 

分 类 号：R657.4[医药卫生—外科学]