摘要目的:腹腔镜下胆囊切除术与小切口胆囊切除术治疗胆囊结石的疗效观察及其对免疫功能的影响。方法:2017年10月至2019年4月间于我院普外科择期手术治疗的104例胆囊结石患者,采用简单随机分组法分为试验组(n=52)和对照组(n=52)。对照组行小切口胆囊切除术,试验组行腹腔镜胆囊切除术,比较两组手术相关情况、并发症发生情况、T淋巴细胞亚群水平。结果:试验组治疗总有效率显著高于对照组(94.2% vs. 76.9%,P<0.05)。试验组术后并发症发生率低于对照组(11.5% vs. 26.9%,P<0.05)。试验组切口总长度、手术时间、术后住院时间、肛门排气时间、下床活动时间均为短于对照组,术中出血量少于对照组(P<0.05)。试验组CD3+、CD4+T、CD4+T/CD8+T水平均高于对照组(P<0.05)。结论:腹腔镜胆囊切除术较小切口胆囊切除术对胆囊结石患者治疗效果更好,免疫抑制作用更小,患者术后恢复更好。
Abstract：Objective: To explore the clinical observation of laparoscopic cholecystectomy and mini-incision cholecystectomy for cholelithiasis and its effect on immune function. Methods: 104 patients with cholecystolithiasis undergoing elective surgery in general surgery of our hospital between October 2017 and April 2019 were divided into the test group(n=52) and the control group(n=52) by simple random grouping method. Patients in the control group were treated with mini-incision cholecystectomy, while patients in the test group were treated with laparoscopic cholecystectomy. The operation conditions, postoperative complications and T lymphocyte subsets between the two groups were compared. Results: The total effective rate of the test group was significantly higher than that of the control group (94.2% vs 76.9%, P<0.05). The incidence of postoperative complications in the test group was lower than that in the control group (11.5% vs. 26.9%, P<0.05). The total incision length, operation time, postoperative hospitalization time, anal exhaust time and ambulation time of the taet group were shorter than those of the control group, and the intraoperative blood loss was less than that of the control group (P<0.05). The levels of CD3+T, CD4+T, CD4+T/CD8+T in the test group were higher than those in the control group (P<0.05). Conclusion: Laparoscopic cholecystectomy with smaller incision cholecystectomy has better therapeutic effect on patients with gallstone, less immunosuppression and better postoperative recovery.
方剑, 开喆, 陈祝明. 腹腔镜下胆囊切除术与小切口胆囊切除术治疗胆囊结石的疗效观察及其对免疫功能的影响[J]. 河北医学, 2020, 26(7): 1062-1065.
FANG Jian, KAI Zhe, CHEN Zhuming. Clinical Observation of Laparoscopic Cholecystectomy and Mini-incision Cholecystectomy for Cholelithiasis and its Effect on Immune Function. HeBei Med, 2020, 26(7): 1062-1065.
[1] Li D, Li YL, Wang WJ, et al. Percutaneous transhepatic papilla balloon dilatation combined with a percutaneous transcystic approach for removing concurrent gallbladder stone and common bile duct stone in a patient with billroth II gastrectomy and acute cholecystitis: A case report[J]. Medicine (Baltimore), 2017, 96(35): e7964. [2] Grau-Talens EJ, Motos-Mico JJ, Giraldo-Rubio R, et al. Small-incision cholecystectomy (through a cylinder retractor) under local anaesthesia and sedation: a prospective observational study of five hundred consecutive cases[J]. Langenbecks Arch Surg, 2018, 403(6): 733~740. [3] Sucandy I, Nadzam G, Duffy AJ, et al. Two-Port laparoscopic cholecystectomy: 18 patients human experience using the dynamic laparoscopic novatract retractor[J].Laparoendosc Adv Surg Tech A, 2016, 26(8): 625~629. [4] Singh AN, Kilambi R. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis[J].Surg Endosc, 2018, 32(9): 3763~3776. [5] 崔磊,瞿建国.腹腔镜与小切口胆囊切除术治疗胆囊结石合并胆囊炎疗效预后及生活质量比较研究[J].河北医学,2016,22(4):540~543. [6] Rashid T, Naheed A, Farooq U, et al. Conversion of laparoscopic cholecystectomy into open cholecystectomy: an experience in 300 cases[J].Ayub Med Coll Abbottabad, 2016, 28(1): 116~119. [7] 高俊,陈功.不同方法胆囊切除术对胆结石患者血清免疫球蛋白和肠黏膜损伤程度的影响[J].实用肝脏病杂志,2018,21(3):443~446. [8] Dong J, Li J, Cui L, et al. Cortisol modulates inflammatory responses in LPS-stimulated RAW264.7 cells via the NF-κB and MAPK pathways[J]. BMC Vet Res, 2018, 14(1): 30. [9] Jaafar G, Hammarqvist F, Enochsson L, et al. Patient-related risk factors for postoperative infection after cholecystectomy[J]. World Surg, 2017, 41(9): 2240~2244.
2020, Vol. 26 
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