免气腹及气腹腹腔镜胆囊切除术的对比研究

目的探讨免气腹腹腔镜胆囊切除术(gsaless laparoscopic cholecystectomy,GLC)的临床应用价值及其对机体的应激反应和肩部疼痛的影响。方法 2010年3月至2014年1月为46例患者行GLC,,同期为48例患者行传统LC。观察两组在手术时间、术后即时动脉血气分析、术后第一天血白细胞、C反应蛋白(CRP)、促肾上腺皮质激素(ACTH)、白介素6(IL-6)、前列腺素E2(PGE2)的同异和术后患者肩部疼痛的程度。结果 GLC组和传统LC组在手术时间、术后即时动脉血气分析、术后第一天血白细胞(WBC)、IL-6和术后6 h患者肩部疼痛2组比较差异有统计学意义。而在术后第一天血CRP、ACTH、PGE2和术后24 h肩部疼痛评分方面2组比较差异无统计学意义。结论 GLC是一种安全、有效的手术方式,它可避免气腹手术的CO2相关并发症,拓宽了腹腔镜手术的应用范围,具有在临床推广使用的价值。

Comparative study of gas and gasless laparoscopic cholecystectomy

Objective To investigate gasless laparoscopic cholecystectomy （gsaless laparoscopic cholecystectomy, GLC） affect the clinical application value of stress reaction and shoulder pain. Methods In 2010 March to 2014 January 46 patients underwent GLC, over the same period, 4s8 patients underwent conventional LC. Observation of the two groupsin the operation time, immediate postoperative arterial blood gas analysis ,after the first day of white blood cells, C reactive protein （CRP）, adrenocorticotropic hormone （ACTH）, interleukin 6 （IL-6）, prostaglandin E2 （PGE2） levels in patients with shoulder pain after operation and the same. Results the GLC group and the traditional group LC in the operation time, immediate postoperative arterial blood gas analysis, after the first day of white bloodcell（ WBC）, there was statistical significance in IL-6and 6 hours after surgery in patients with shoulder pain, the difference between the 2 groups. But no significant difference was found in the first postoperative day, serum CRP, ACTH, PGE2 andafter 24 hours ofshoulder painscore difference between the 2 groups. Conclusion GLC is a safe, effective operationmode, it can avoidthe complications related to CO2pneumoperitoneumoperation, broaden the scope of applicationof laparoscopic operation, isin clinical use.