经脐入路内镜胆囊切除术对老年患者机体创伤反应的研究

目的：探讨经脐入路内镜胆囊切除术在治疗≥60岁老年患者术后的创伤反应。方法将60例60岁以上患慢性胆囊疾病行择期手术的老年患者，随机分为经脐入路内镜胆囊切除术组（TUEC，30例），与三孔腹腔镜胆囊切除组（LC，30例）。术后即刻、术后6 h、术后24 h 抽取外周静脉血，测定 IL-6和 CRP 的浓度；记录手术时间、术中失血量、止痛药的使用、恢复饮食的时间、术后住院天数及术后并发症等常规项目。结果 LC 组的 IL-6和 CRP 水平略高于 TUEC 组，但比较均无统计学意义；手术时间、术中失血量、恢复饮食的时间、术后住院天数及术后并发症等项目比较无显著性差异；术后止痛药的使用 TUEC 组明显小于 LC 组，有显著差异（P 〈0.05）。结论经脐入路内镜胆囊切除术与多孔 LC 一样，创伤反应小，安全、可行；同时美容效果好、切口疼痛轻，可应用于老年患者。

Study of wound reaction to transumbilical endoscopic cholecystectomy of geriatric patients

Objectives To discuss wound reaction of postoprative transumbilical endoscopic cholecystectomy in geriatric patietns. Methods Elderly patients over 60 years with chronic gallbladder diseases were divided into two groups：30 cases with transumbilical endoscopic cholecystectomy（ TUEC） group and 30 cases with laparoscopic cholecystectomy（LC）group. IL-6 and C-reactive protein（ CRP） were tested at the end of operation,6 h postoperation and 12 h postoperation. Operation time,bleeding amount,use anodyne,time of recovery diet,complications and postoperational hospitalization day were recorded. Results Serum concentrations of IL-6 and CRP of LC group were higer than those of TUEC group,but there were no significant difference between the two groups. Operation time,bleeding amount, time of recovery diet,complications and postoperational hospitalization day also showed no significant difference between TUEC group and LC group. Comparing the analgesic requirements after operation,TUEC group was less than LC group（P 〈 0. 05）. Conclusion Transumbilical endoscopic cholecystectomy is a safe and feasible technique,which has at least equivalent perioperative outcomes to LC with obvious advantages of cosmesis and theoretical advantages of reduced analgesic requirements and well-being in the geriatrics group.