Clinical effects of laparoscopy and laparotomy in treatment of gangrenous cholecystitis
-
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...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.
-
Key words:
- cholecystitis,acute /
- cholecystectomy,laparoscopic /
- laparoscopy /
- inflammation mediators
-
[1]COCCOLINI F,CATENA F,PISANO M,et al.Open versus laparoscopic cholecystectomy in acute cholecystitis.Systematic review and meta-analysis[J].Int J Surg,2015,18:196-204. [2]JIANG B,FU YF,CHEN XP.Laparoscopic cholecystectomy for the treatment of acute gangrenous cholecystitis:an analysis on 69cases[J].Chin J Gen Surg,2007,22(6):413-415.(in Chinese)江斌,付应峰,陈孝平.急性坏疽性胆囊炎69例的腹腔镜治疗[J].中华普通外科杂志,2007,22(6):413-415. [3]WU BQ,JIANG Y,ZHU F,et al.The clinical experences on the treatment of elderly patients with acute gangrenous cholecystitis by laparoscopic cholecystectomy[J].J Hepatopancreatobiliary Surg,2014,26(5):368-371.(in Chinese)吴宝强,江勇,朱峰,等.腹腔镜下胆囊切除治疗老年坏疽性胆囊炎的临床体会[J].肝胆胰外科杂志,2014,26(5):368-371. [4]AYDIN C,ALTACA G,BERBER I,et al.Prognostic parameters for the prediction of acute gangrenous cholecystitis[J].J Hepatobiliary Pancreat Surg,2006,13(2):155-159. [5]MCGILLICUDDY EA,SCHUSTER KM,BARRE K,et al.Non-operative management of acute cholecystitis in the elderly[J].Br J Surg,2012,99(9):1254-1261. [6]TEIXEIRA JP,RIBEIRO C,PINHO A,et al.Laparoscopic cholecystectomy in acute cholecystitis in the elderly[J].Hepatogastroenterology,2014,61(129):18-21. [7]ZEREM E,OMEROVIC S,GUZIN Z,et al.What is the optimal treatment for acute cholecystitis in elderly patients?[J].Eur J Gastroenterol Hepatol,2013,25(6):749. [8]ZHEGN BL.Investigation and clinical analysis on acute gangrenous cholecystitis[J].J North Sichuan Med Col,2013,28(3):273-276.(in Chinese)郑丙来.探讨急性坏疽性胆囊炎的诊疗分析[J].川北医学院学报,2013,28(3):273-276. [9]ZHENG HS,ZHOU YC,MOU YP,et al.Comparison of the efficacies of open and laparoscopic surgery in the treatment of adult patients with congenital choledochal cyst[J].Chin J Dig Surg,2015,14(4):288-293.(in Chinese)郑海水,周育成,牟一平,等.开腹与腹腔镜手术治疗成人先天性胆总管囊肿的疗效比较[J].中华消化外科杂志,2015,14(4):288-293. [10]ZHANG JW,DU P,CHEN DW,et al.Effect of viable bifidobacterium supplement on the immune status and inflammatory response in patients undergoing resection for colorectal cancer[J].Chin J Gastrointestinal Surg,2010,3(1):40-43.(in Chinese)张纪伟,杜鹏,陈大伟,等.补充双歧三联活菌对结直肠癌术后患者免疫状况和炎性反应的影响[J].中华胃肠外科杂志,2010,3(1):40-43. [11]ZHAO YG.Effect of fast track surgery on the effect of gastric cancer operation and release of inlfammatory mediators[J].Chin J Med Guide,2014,16(5):798-799.(in Chinese)赵云刚.快速康复外科对胃癌手术效果及炎症介质释放的影响[J].中国医药导刊,2014,16(5):798-799. [12]WANG H,XU DF,LIU YS,et al.Experimental study for effects of carbon dioxide pneumoperitoneum on the function of macrophage under inflammation[J].J Laparo Surg,2010,15(4):271-274.(in Chinese)王浩,徐丹枫,刘玉杉,等.CO2气腹对炎症环境下巨噬细胞功能影响的实验研究[J].腹腔镜外科杂志,2010,15(4):271-274. -

计量
- 文章访问数: 2316
- HTML全文浏览量: 14
- PDF下载量: 444
- 被引次数: 0