开腹与腹腔镜胆囊切除术治疗坏疽性胆囊炎的效果比较

周劲松; 蒲东利; 杜子友

doi:10.3969/j.issn.1001-5256.2016.05.021

开腹与腹腔镜胆囊切除术治疗坏疽性胆囊炎的效果比较

DOI: 10.3969/j.issn.1001-5256.2016.05.021

青海省格尔木市解放军第二十二医院外一科

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中图分类号: R657.41
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出版历程
- 收稿日期: 2015-11-23
- 出版日期: 2016-05-20

Clinical effects of laparoscopy and laparotomy in treatment of gangrenous cholecystitis

First Surgical Department,22 Hospital of PLA

摘要

摘要: 目的比较腹腔镜胆囊切除术（LC）和开腹胆囊切除术（OC）治疗坏疽性胆囊炎的临床疗效以及对炎性介质的影响。方法选取2012年1月-2015年6月解放军第二十二医院行手术治疗的82例坏疽性胆囊炎患者,其中LC组42例,OC组40例。比较两组患者的手术相关情况及围手术期炎性介质的释放。计量资料比较采用t检验,计数资料比较采用χ2检验。结果两组均无围手术期死亡病例,LC组患者3例（7.14%）中转开腹。两组患者的胆囊部分切除率、手术时间、手术出血量、住院费用比较,差异均无统计学意义（P值均>0.05）。LC组术后住院时间、引流管放置率和术后并发症均低于OC组,但仅术后住院时间差异有统计学意义（t=7.472,P<0.001）。LC组血清白细胞（WBC）、C反应蛋白（CRP）、白细胞介素（IL）6和肿瘤坏死因子（TNF）α术后逐渐下降,术后3、5 d较术前比较,差异均有统计学意义（P值均<0.05）。OC组血清WBC、CRP、IL-6和TNFα术后1 d升高,术后3、5 d逐渐下降,较术前比较,差异均有统计学意义（P值均<0.05）。与OC组比较,L...
- 胆囊炎,急性 /
- 胆囊切除术,腹腔镜 /
- 剖腹术 /
- 炎症介导素类
Abstract: Objective To compare the clinical effects of laparoscopic cholecystectomy( LC) and open cholecystectomy( OC) in the treatment of gangrenous cholecystitis and their influence on inflammatory mediators. Methods A total of 82 patients with gangrenous cholecystitis who underwent surgery in 22 Hospital of PLA from January 2012 to June 2015 were enrolled and divided into LC group( 42 patients) and OC group( 40 patients). The condition of surgery and perioperative levels of inflammatory mediators were compared between the two groups.The t- test was used for comparison between the two groups,and the chi- square test was used for categorical data. Results All the patients underwent the surgery successfully without deaths during the perioperative period,and three patients were converted to laparotomy.The rate of partial cholecystectomy,time of operation,intraoperative blood loss,and hospital costs showed no significant differences between the two groups( all P > 0. 05). The LC group had a shorter length of postoperative hospital stay,a lower rate of drainage tube placement,and fewer postoperative complications compared with the OC group,but only the length of postoperative hospital stay showed a significant difference between the two groups( t = 7. 472,P < 0. 001). The LC group experienced significant reductions in the serum white blood cell count( WBC),C- reactive protein( CRP),interleukin- 6( IL- 6),and tumor necrosis factor α( TNFα) on days 3 and 5 after surgery( all P < 0. 05). The OC group experienced significant increases in serum WBC,CRP,IL- 6,and TNFα on day 1 after surgery,and significant reductions in these indices on days 3 and 5 after surgery( all P < 0. 05). The LC group had significantly lower serum WBC,CRP,IL- 6,and TNFα on days 1,3,and 5 after surgery compared with the OC group( all P < 0. 05). Conclusion LC is safe and effective in the treatment of gangrenous cholecystitis. Compared with OC,LC has the advantages of less trauma and faster recovery after surgery and can reduce the release of inflammatory mediators.
- cholecystitis,acute /
- cholecystectomy,laparoscopic /
- laparoscopy /
- inflammation mediators

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参考文献(12)

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