不同入路腹腔镜手术治疗对胆囊结石伴慢性胆囊炎患者免疫应激反应的影响

doi:10.3969/j.issn.1006-6233.2022.11.021

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摘要 目的: 探讨不同入路方式腹腔镜手术治疗对胆囊结石伴慢性胆囊炎患者免疫应激反应的影响。方法: 选取2020年3月至2022年3月期间本院收治的拟行腹腔镜手术治疗的胆囊结石伴慢性胆囊炎患者95例作为研究对象,依据随机数字表法简单随机分为前三角入路组(n=47)和后三角入路组(n=48)。比较两组围术期相关指标(手术时间、术中出血量、肠功能恢复时间以及住院时间)、术后12h及24h的疼痛程度、术前及术后3d的应激指标[白细胞介素-6(IL-6)、C反应蛋白(CRP)、皮质醇]、免疫功能指标(CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺)水平,并比较两组的术后并发症情况。结果: 后三角入路组手术时间、术中出血量、肠功能恢复时间以及住院时间均少于前三角入路组(P<0.05);后三角入路组术后12h、24h疼痛视觉模拟评分量表(VAS)评分均明显低于前三角入路组(P<0.05);术后3d,两组IL-6、CRP、皮质醇等应激指标水平均较术前明显升高(P<0.05),其中后三角入路组各指标升高幅度明显低于前三角入路组(P<0.05);术后3d,两组CD3⁺、CD4⁺、CD4⁺/CD8⁺均低于术前(P<0.05),CD8⁺较术前无明显变化(P>0.05),其中后三角入路组CD3⁺、CD4⁺、CD4⁺/CD8⁺降低幅度明显低于前三角入路组(P<0.05),两组CD8⁺比较差异不显著(P>0.05);后三角入路组的术后并发症总发生率为6.00%,显著低于前三角入路组的22.22%(P<0.05)。结论: 与胆囊前三角解剖入路相比,经胆囊后三角解剖入路的腹腔镜胆囊切除术手术可减少手术时间、术中出血量、肠功能恢复时间以及住院时间,且能够明显改善机体应激反应,促进机体免疫功能恢复,术后并发症少,值得临床推广应用。

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	方利霞
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关键词 ：胆囊结石伴慢性胆囊炎, 腹腔镜手术, 前三角解剖入路, 后三角解剖入路, 免疫功能, 应激反应

Abstract：Objective: To investigate the effect of different approaches of laparoscopic surgery on immune stress in patients with cholecystolithiasis complicated with chronic cholecystitis.Methods: From March 2020 to March 2022, 95 patients with cholecystolithiasis complicated with chronic cholecystitis who were treated by laparoscopic surgery in our hospital were selected as the research subjects. According to the random number table method, they were divided into anterior triangle approach group (n=47) and posterior triangle approach group (n=48). The perioperative related indicators (operation time, intraoperative blood loss, bowel function recovery time and hospitalization time), pain level at 12 h and 24 h after operation, and stress indexes before operation and 3 days after operation [leukocyte] were compared between the two groups. The levels of interleukin-6 (IL-6), C-reactive protein (CRP), cortisol], and immune function indexes (CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺), and postoperative complications were compared between the two groups. Results: The operation time, intraoperative blood loss, bowel function recovery time and hospital stay in the posterior triangle approach group were all shorter than those in the anterior triangle approach group (P<0.05). The analog scale (VAS) scores were significantly lower than those in the anterior triangle approach group (P<0.05); 3 days after operation, the levels of IL-6, CRP, cortisol and other stress indexes in the two groups were significantly higher than those before operation (P<0.05), and the indexes ascending range in the posterior triangle approach group were significantly lower than those in the anterior triangle approach group (P<0.05); 3 days after operation, CD3⁺, CD4⁺, CD4⁺/CD8⁺ in both groups were lower than those before operation (P<0.05), no significant change in CD8+ compared with preoperative (P>0.05), the reducing range of CD3⁺, CD4⁺, CD4⁺/CD8⁺ in the posterior triangle approach group were significantly higher than those in the anterior triangle approach group (P<0.05), and there were differences in CD8⁺ between the two groups Not significant (P>0.05); the total incidence of postoperative complications in the posterior triangle approach group was 6.00%, which was significantly lower than that in the anterior triangle approach group (22.22%) (P<0.05). Conclusion: Compared with the anterior triangular anatomical approach of the gallbladder, the laparoscopic cholecystectomy via the posterior gallbladder triangular anatomical approach can shorten the operation time, reduce intraoperative blood loss, intestinal function recovery time and hospitalization time, and can significantly improve the body's stress response, promote the recovery of the body's immune function, and reduce postoperative complications, which is worthy of clinical application.

Key words： Cholecystolithiasis complicated with chronic cholecystitis Laparoscopic surgery Anterior triangular anatomical approach Posterior triangular anatomical approach Immune function Stress response

基金资助:湖北省医学科技攻关计划项目,(编号:2020CFB355)

引用本文:

方利霞, 李平, 王水元, 吴桐. 不同入路腹腔镜手术治疗对胆囊结石伴慢性胆囊炎患者免疫应激反应的影响[J]. 河北医学, 2022, 28(11): 1865-1868.
FANG Lixia, LI Ping, WANG Shuiyuan, et al. Effect of Laparoscopic Surgery with Different Approaches on the Immune Stress Response in Patients with Cholecystolithiasis Complicated with Chronic Cholecystitis. HeBei Med, 2022, 28(11): 1865-1868.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.11.021 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I11/1865

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