早期不同时机行腹腔镜胆囊切除术治疗急性胆囊炎的临床效果

目的探讨早期不同时机行腹腔镜胆囊切除术(LC)治疗急性结石性胆囊炎的临床效果。方法采用便利抽样法选取2018年4月至2019年4月在我院行LC治疗的236例患者为研究对象,按治疗时机的不同将其分为对照组和观察组,各118例。对照组于发病后48~72 h内实施LC术,观察组于发病后48 h内行LC术。比较两组患者的手术时间、术中出血量、肛门排气时间、住院时间、中转开腹率、术前及术后1、3 d的免疫功能指标水平、术后并发症发生情况及远期生活质量。结果观察组的手术时间、肛门排气时间及住院时间均短于对照组,术中出血量少于对照组,中转开腹率低于对照组,差异具有统计学意义(P<0.05)。术后1 d,两组患者的CD3^+水平及CD4^+/CD8^+均有所下降,但观察组高于对照组(P<0.05);术后3 d,两组患者的CD3^+水平及CD4^+/CD8^+均高于术前及术后1 d,且观察组高于对照组,差异具有统计学意义(P<0.05)。观察组的并发症总发生率低于对照组,差异具有统计学意义(P<0.05)。随访6个月,观察组的GLQI评分高于对照组,差异具有统计学意义(P<0.05)。结论急性胆囊炎患者于发病48 h内进行LC可改善其临床相关指标,降低中转开腹率和术后并发症发生率,提高免疫能力和生活质量,值得临床推广。

Clinical effect of laparoscopic cholecystectomy at early different timing on acute cholecystitis

Objective To investigate the clinical effect of laparoscopic cholecystectomy(LC)at early different timing on acute cholecystitis.Methods A total of 236 patients who underwent LC treatment in our hospital from April 2018 to April 2019 were selected as the study objects by convenient sampling method.According to the different timing of treatment,the patients were divided into control group and observation group,with 118 cases in each group.In the control group,LC was performed within 48-72 h after the onset of the disease,and in the observation group,LC was performed within 48 h after the onset of the disease.The operation time,intraoperative bleeding volume,anal exhaust time,hospitalization time,the rate of conversion to laparotomy,the levels of immune function indexes before and 1 and 3 days after operation,postoperative complications and long-term quality of life were compared between the two groups.Results The operative time,anal exhaust time and hospitalization time of the observation group were shorter than those of the control group,the intraoperative bleeding volume was less than that of the control group,and the rate of conversion to laparotomy was lower than that of the control group,the differences were statistically significant(P<0.05).At 1 day after operation,CD3^+level and CD4^+/CD8^+decreased in both groups,but those in the observation group were higher than the control group(P<0.05);at 3 days after the operation,CD3^+level and CD4^+/CD8^+in both groups were higher than those before the operation and 1 day after the operation,and those in the observation group were higher than the control group,the differences were statistically significant(P<0.05).The total incidence of complications in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).After 6 months of follow-up,the GLQI score of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).Conclusion LC in patients with acute cholecystitis within 48 hours after the onset of the disease can improve the clinical relevant indexes,reduce the rate of conversion to laparotomy and postoperative complications,improve the immune ability and quality of life,which is worthy of clinical promotion.