1、65临床研究 2023 年 03 月第 31 卷第 03 期作者简介：姚安峰，男，副主任医师，本科。研究方向：甲状腺、乳腺、肝胆胰脾、胸部创伤以及腹腔镜手术等。临床治疗腹腔镜下胆囊切除术治疗胆囊结石临床疗效及并发症分析姚安峰(中牟县中医院 普外科，河南 郑州 450000)摘要：目的 探讨腹腔镜下胆囊切除术治疗胆囊结石临床疗效及并发症。方法 纳入中牟县中医院 2020 年 3 月至2022 年 3 月确诊胆囊结石的 82 例患者入组，基于随机数字表法分组，其中 41 例采用传统开腹胆囊切除术治疗患者纳入开腹组，41 例采用腹腔镜胆囊切除术治疗患者纳入腹腔镜组，比较两组治疗效果。比较两组手术指标
2、(术后肛门排气时间、排便时间、下床活动时间、肠鸣音恢复时间、术后住院时间)；术后 6 h、术后 12 h、术后 24 h 疼痛评分，以及术前、术后 24 h 应激反应指标 血清皮质醇(Cor)、-内啡肽(-EP)、血管紧张素(Ang-)、炎症反应指标 C 反应蛋白(CRP)、肿瘤坏死因子(TNF-)、白介素-6(IL-6)、白介素-10(IL-10)水平；比较两组术后并发症发生率差异。结果 腹腔镜组肛门排气时间、排便时间、下床活动时间、肠鸣音恢复时间和术后住院时间均短于开腹组，差异有统计学意义(P 0.05)。与开腹组相比，腹腔镜组术后 12 h、术后 24 h 疼痛评分显著降低，差异有统计学
3、意义(P 0.05)。与术前比较，术后 24 h 两组患者血清 Cor、-EP、Ang-水平均升高，但腹腔镜组低于开腹组，差异有统计学意义(P 0.05)。与术前比较，术后 24 h 两组患者 CRP 和 TNF-、IL-6、IL-10 水平均升高，但腹腔镜组低于开腹组，差异有统计学意义(P 0.05)。两组并发症发生率比较，差异无统计学意义(P 0.05)。结论 腹腔镜下胆囊切除术相较于开腹胆囊切除治疗胆囊结石患者效果更佳，减轻机体的炎症应激反应的同时缩短术后恢复时间，具备较高的有效性和安全性，但在降低术后并发症方面还需开展大样本多中心进行深入研究。关键词：腹腔镜；胆囊切除术；胆囊结石；并发
4、症中图分类号：R575.6文献标志码：B DOI：10.12385/j.issn.2096-1278(2023)03-0065-04Clinical Effect and Complication Analysis of Laparoscopic Cholecystectomy for CholecystolithiasisYAO Anfeng(Department of General Surgery,Zhongmu County Hospital of Traditional Chinese Medicine,Zhengzhou Henan 450000,China)Abstract:Ob
5、jective To investigate the clinical effect and complications of laparoscopic cholecystectomy for cholecystolithiasis.Methods A total of 82 patients diagnosed with cholecystolithiasis in Zhongmu County Hospital of Traditional Chinese Medicine from March 2020 to March 2022 were enrolled and grouped ba
6、sed on the random number table method.Among them,41 patients treated with traditional cholecystectomy were included in the laparotomy group and 41 patients treated with laparoscopic cholecystectomy were included in the laparoscopic group.The therapeutic effects of the two groups were compared.The in
7、dexes(Postoperative anal exhaust time,defecation time,getting out of bedtime,bowel sound recovery time,and postoperative hospital stay time)of the two groups were compared.The pain scores at 6 h,12 h,and 24 h after surgery,and the levels of stress response indexes serum cortisol(Cor),-endorphin(-EP)
8、,angiotensin (Ang-)and infiammatory response indexes C-reactive protein(CRP),tumor necrosis factor-(TNF-),interleukin-6(IL-6),interleukin-10(IL-10)before operation and 24 hours after operation were also measured.The incidence of postoperative complications was compared between the two groups.Results
9、 The anal exhaust time,defecation time,getting out of bedtime,bowel sound recovery time and postoperative hospitalization time in the laparoscopic group were all shorter than those in the laparotomy group,and the differences were statistically significant(P 0.05).Compared with the laparotomy group,t
10、he pain scores of the laparoscopic group significantly decreased at 12 h and 24 h after surgery,with statistical significance(P 0.05).Compared with the preoperative level,the serum Cor,-EP,and Ang levels in the two groups were increased 24 h after surgery,but the laparoscopy group was lower than the
11、 laparotomy group,the difference was statistically significant(P 0.05).Compared with the preoperative level,the levels of CRP,TNF-,IL-6,and IL-10 in the two groups were increased 24 h after surgery,but the laparoscopy group was lower than the laparotomy group,the difference was statistically signifi
12、cant(P 0.05).There was no significant difference in the incidence of complications between the two groups(P 0.05).Conclusion Compared with open cholecystectomy,laparoscopic cholecystectomy is more effective in the treatment of patients with cholecystolithiasis,which can reduce the infiammatory stres
13、s response of the body and shorten the postoperative recovery time.Therefore,laparoscopic cholecystectomy has high efficacy and safety.However,in terms of reducing postoperative complications,further studies with large samples and multiple centers are needed.Key Words:laparoscopy;cholecystectomy;gal
14、lstone;complications胆囊结石作为肝胆外科常见的良性疾病，一般经胆囊内 B 超检查发现高回声可以移动的病灶，且出现饱餐后上腹部胀痛的症状，墨菲斯征的检查显示阳性即可确诊为胆囊结石1。胆囊结石形成和多种因素有关，在我国西北地区的胆囊结石发病率相对较高，可能与饮食习惯有关2。胆囊结石的典型症状为急性胆管炎引发的腹痛、高热、寒战等，若未得到及时治疗极易引起重症急性胆管炎、胆道出血、胆源性肝脓肿、胆汁性肝硬化、胆管癌等并发症，因此临床针对上述疾病一般建议患者尽早接受手术治疗，谨防疾病恶化造成的更严重影响3。既往以传统开腹胆囊切除术(开腹)应用3-4较为频繁，但因其创伤大、术后并发症多
15、、康复进程慢等劣势，在66Clinical Research,Mar.2023,Vol.31 No.03一定程度上限制其应用范围。随着微创医学研究的不断发展，腹腔镜胆囊切除术(腹腔镜)逐渐得到临床医师及患者的青睐。然而相关研究表明5，受结石导致胆管堵塞的影响，局部炎症会使得胆囊壁和 Calot 三角发生粘连，增加腹腔镜治疗难度，影响其治疗效果，加之气腹的建立容易损伤静脉血管，增加术后血栓形成的风险。因此，临床对其治疗有效性和安全性始终存疑。对此，本研究选取中牟县中医院收治的 82 例患者的临床资料进行分析，比较腹腔镜和开腹治疗胆囊结石的安全性和有效性，报道如下。1资料与方法1.1两组一般资料比
16、较选取本院于 2020 年 3 月至 2022 年 3 月收治的胆囊结石患者为研究对象。纳入研究对象 82 例，基于随机数字表法分为开腹组(开腹操作)和腹腔镜组(腹腔镜下胆囊切除)，每组各 41 例，两组资料经比较提示，差异无统计学意义(P 0.05)，具有可比性。见表 1。本研究经本院医学伦理委员会批准。表 1两组一般资料比较 n(%)，sx 组别例数性别年龄/岁体质量指数/(kg/m2)Child-Pugh 分级男女A 级B 级开腹组4125(60.98)16(39.02)37.056.4322.070.5421(51.22)20(48.78)腹腔镜组4122(53.66)19(46.34)37.086.5522.100.5824(58.54)17(41.46)2/t0.4640.1440.2390.653P0.4960.8860.8110.128纳入标准：均结合体征、症状及腹部 B 超等检查确诊是胆囊结石，与有关手术指征相符6；符合腹腔镜胆囊切除术要求；年龄不低于 18 岁；认知功能无异常。且依从性良好；临床资料完整。排除标准：胆道存在恶性疾病者；中转开腹术式者；造血系统或者血液