腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎患者治疗效果分析

目的 探讨采用腹腔镜胆囊切除术(LC)治疗胆囊结石伴慢性胆囊炎患者的治疗效果及血清胃泌素(GAS)、胃动素(MOT)和血管活性肠肽(VIP)水平的变化。方法 2018年3月～2020年3月我院普外科就诊的70例胆囊结石伴慢性胆囊炎患者,采用随机数字表法将患者分为对照组35例和观察组35例,分别行小切口胆囊切除术或行LC术治疗。采用ELISA法检测血清肿瘤坏死因子-ɑ(TNF-ɑ)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、GAS、MOT和VIP水平。结果 观察组手术持续时间为(60.6±6.5)min,显著短于对照组【(95.4±7.2)min,P<0.05】,术后住院日为(5.3±1.4)d,显著短于对照组【(7.7±2.5)d,P<0.05】,术中出血量为(42.3±12.4)mL,显著少于对照组【(124.5±21.7)mL,P<0.05】;术后3 d,观察组血清谷氨酰转肽酶(GGT)水平为(41.4±9.3)U/L,显著低于对照组【(65.1±10.5)U/L,P<0.05】,血清天冬氨酸氨基转移酶(AST)水平为(45.3±17.5)U/L,显著低于对照组【(71.2±19.7)U/L,P<0.05】,血清丙氨酸氨基转移酶(ALT)水平为(28.0±20.5)U/L,显著低于对照组【(59.5±22.8)U/L,P<0.05】;血清CRP水平为(28.4±8.3)ng/L,显著低于对照组【(35.7±8.7)ng/L,P<0.05】,血清IL-6水平为(42.4±5.3)ng/L,显著低于对照组【(47.7±6.7)ng/L,P<0.05】,血清TNF-ɑ水平为(1.9±0.5)μg/L,显著低于对照组【(4.7±0.9)μg/L,P<0.05】;血清GAS水平为(129.5±12.4)ng/L,显著高于对照组【(112.7±10.6)ng/L,P<0.05】,血清MOT水平为(242.4±38.7)ng/L,显著高于对照组【(197.6±42.4)ng/L,P<0.05】,和血清VIP水平为(18.2±3.7)pg/mL,显著低于对照组【(22.8±5.3)pg/mL,P<0.05】;术后,观察组并发症发生率为8.6%,显著低于对照组(20.0%,P<0.05)。结论 采用LC治疗胆囊结石伴慢性胆囊炎患者可明显改善手术相关指标,降低血清VIP水平,升高血清GAS和MOT水平,改善胃肠功能,手术安全,疗效肯定。

Efficacyof laparoscopic cholecystectomy in the treatment of patients with gallstones and chronic cholecystitis

Objective To investigate the efficacy of laparoscopic cholecystectomy(LC)in the treatment of patients with gallstones and chronic cholecystitis.Methods 70 patients with gallstones and chronic cholecystitis were enrolled in our hospital between March 2018 and March 2020,and were randomly divided into control group(n=35)and observation group(n=35).The patients in the control group were treated with open cholecystectomy with small incision,and those in the observation group were treated with LC.Serum gastrin(GAS),vactive intestinal peptide(VIP)and motilin(MOT)levels were detected by ELISA.Results The operationtime in the observation group was(60.6±6.5)min,which was significantly shorter than that in the control group(95.4±7.2)min,P<0.05],the postoperative hospital stay was(5.3±1.4)d,which was significantly shorter than that in the control group(7.7±2.5)d,P<0.05],and the intraoperative blood loss was(42.3±12.4)mL,which was significantly less than that in the control group(124.5±21.7)mL,P<0.05];serum glutamyl transferase(GGT)level in the observation group was(41.4±9.3)U/L,which was significantly lower than in the control group(65.1±10.5)U/L,P<0.05],serum aspartate aminotransferase(AST)level was(45.3±17.5)U/L,which was significantly lower than in the control group(71.2±19.7)U/L,P<0.05],and serum alanine aminotransferase(ALT)level was(28.0±20.5)U/L,which was significantly lower than in the control group(59.5±22.8)U/L,P<0.05];serum C-reactive protein(CRP)level was(28.4±8.3)ng/L,which was significantly lower than in the control group(35.7±8.7)ng/L,P<0.05],serum interleukin-6(IL-6)level was(42.4±5.3)ng/L,which was significantly lower than that in the control group(47.7±6.7)ng/L,P<0.05],serum tumor necrosis factor-ɑ(TNF-ɑ)level was(1.9±0.5)μg/L,which was significantly lower than that in the control group(4.7±0.9)μg/L,P<0.05];serum GAS level was(129.5±12.4)ng/L,which was significantly higher than that in the control group(112.7±10.6)ng/L,P<0.05],serum MOT level was(242.4±38.7)ng/L,which was significantly higher than that in the control group(197.6±42.4)ng/L,P<0.05],and serum VIP level was(18.2±3.7)pg/mL,which was significantly lower than that in the control group(22.8±5.3)pg/mL,P<0.05];after operation,the incidence of complications in the observation group was 8.6%,significantly lower than that in the control group(20.0%,P<0.05).Conclusion The application of laparoscopic cholecystectomy for treatment of patients with gallstones and chronic cholecystitis is efficacious,which might significantly decrease serum VIP level and increase serum GAS and MOT levels,improve gastrointestinal function restoration,and relieve inflammation reaction.