不同手术入路腹腔镜胆囊切除术临床疗效及安全性研究*

目的 观察不同手术入路对腹腔镜胆囊切除术(LC)临床疗效及安全性的影响。方法 2016年1月～2018年1月在我院行LC治疗的136例胆囊良性疾病患者,采用随机数字表法分为A组68例和B组68例。在A组,采用侧方入路剥离胆囊,在B组采用顺行或逆行剥离胆囊。随访3个月。采用视觉模拟量表(VAS)进行疼痛程度评分,采用酶联免疫吸附法检测血清C反应蛋白(CRP)、白介素-6(IL-6)、中性粒细胞弹性蛋白酶(NE)和肿瘤坏死因子-α(TNF-α)。结果 A组和B组手术成功率分别为97.1%和95.6%,分别有2例和3例中转开腹,差异无统计学意义(P>0.05);在术后6 h,A组VAS评分为(3.1±0.6)分,显著低于B组【(4.1±1.0)分,P＜0.05】,在术后12 h,A组VAS评分为(1.5±0.5)分,显著低于B组【(3.1±0.7)分,P＜0.05】;术后,A组血清CRP、IL-6、NE和TNF-α水平分别为(2.9±1.3)mg/L、(3.3±0.7)ng/L、(1.2±0.5)μg/L和(0.9±0.7)ng/L,均显著低于B组【分别为(4.2±1.6)mg/L、(4.8±1.5)ng/L、(2.6±0.9)μg/L和(1.9±0.8)ng/L,P<0.05】;在随访3个月时,A组胆囊破裂、胆囊床渗出等并发症发生率为7.4%,显著低于B组的23.5%(P<0.05)。结论 在腹腔镜胆囊切除术中经侧方入路与顺行或逆行剥离胆囊均能获得满意的临床治疗疗效,但前者在减小创伤和并发症发生方面具有优势,值得临床应用。

Clinical efficacy and safety of laparoscopic cholecystectomy in treatment of patients with benign gall bladder diseases

Objective The aim of this study was to observe the clinical efficacy and safety of laparoscopic cholecystectomy(LC)in treatment of patients with benign gall bladder diseases.Methods 136 patients with benign gallbladder diseases were recruited in our hospital between January 2016 and January 2018,and all of them underwent LC.During the operation,the lateral approach to remove the gallbladder were conducted in 68 patients in group A,and the antegrade or retrograde approached to remove gallbladder were conducted in another 68 patients in group B.The post-operational pain was evaluated by visual analogue scales,and serum C-reactive protein(CRP),interleukin-6(IL-6),neutrophil elastase(NE)and tumor necrosis factor-α(TNF-α)levels were assayed.Results The successful rates of operation in group A and in group B were 97.1%and 95.6%,and the conversion to open operation was 2.9%and 4.4%,respectively(P>0.05);6 hours after operation,the VAS score in group A was(3.1±0.6),much lower than(4.1±1.0),P<0.05],and 12 hours after operation,the VAS score was(1.5±0.5),significantly lower than(3.1±0.7),P<0.05]in group B;after operation,serum CRP,IL-6,NE and TNF-αlevels in group A were(2.9±1.3)mg/L,(3.3±0.7)ng/L,(1.2±0.5)μg/L and(0.9±0.7)ng/L,significantly lower than(4.2±1.6)mg/L,(4.8±1.5)ng/L,(2.6±0.9)μg/L and(1.9±0.8)ng/L,respectively,P<0.05]in group B;at the end of three-month follow-up,the incidence of post-operational complications,such as gallbladder rupture or gallbladder bed exudation,in group A was 7.4%,much lower than 23.5%(P<0.05)in group B.Conclusions Laparoscopic cholecystectomy by through lateral approach to remove gallbladder might achieve satisfactory clinical outcomes,which could reduce trauma and post-operational complications.