腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎患者治疗效果分析

doi:10.3969/j.issn.1672-5069.2021.02.032

摘要/Abstract

摘要： 目的探讨采用腹腔镜胆囊切除术(LC)治疗胆囊结石伴慢性胆囊炎患者的治疗效果及血清胃泌素(GAS)、胃动素(MOT)和血管活性肠肽(VIP)水平的变化。方法 2018年3月～2020年3月我院普外科就诊的70例胆囊结石伴慢性胆囊炎患者,采用随机数字表法将患者分为对照组35例和观察组35例,分别行小切口胆囊切除术或行LC术治疗。采用ELISA法检测血清肿瘤坏死因子-ɑ(TNF-ɑ)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、GAS、MOT和VIP水平。结果观察组手术持续时间为(60.6±6.5)min,显著短于对照组【(95.4±7.2)min,P<0.05】,术后住院日为(5.3±1.4)d,显著短于对照组【(7.7±2.5)d,P<0.05】,术中出血量为(42.3±12.4)mL,显著少于对照组【(124.5±21.7)mL,P<0.05】;术后3 d,观察组血清谷氨酰转肽酶(GGT)水平为(41.4±9.3)U/L,显著低于对照组【(65.1±10.5)U/L,P<0.05】,血清天冬氨酸氨基转移酶(AST)水平为(45.3±17.5)U/L,显著低于对照组【(71.2±19.7)U/L,P<0.05】,血清丙氨酸氨基转移酶(ALT)水平为(28.0±20.5)U/L,显著低于对照组【(59.5±22.8)U/L,P<0.05】;血清CRP水平为(28.4±8.3)ng/L,显著低于对照组【(35.7±8.7)ng/L,P<0.05】,血清IL-6水平为(42.4±5.3)ng/L,显著低于对照组【(47.7±6.7)ng/L,P<0.05】,血清TNF-ɑ水平为(1.9±0.5)μg/L,显著低于对照组【(4.7±0.9)μg/L,P<0.05】;血清GAS水平为(129.5±12.4)ng/L,显著高于对照组【(112.7±10.6)ng/L,P<0.05】,血清MOT水平为(242.4±38.7)ng/L,显著高于对照组【(197.6±42.4)ng/L,P<0.05】,和血清VIP水平为(18.2±3.7)pg/mL,显著低于对照组【(22.8±5.3)pg/mL,P<0.05】;术后,观察组并发症发生率为8.6%,显著低于对照组(20.0%,P<0.05)。结论采用LC治疗胆囊结石伴慢性胆囊炎患者可明显改善手术相关指标,降低血清VIP水平,升高血清GAS和MOT水平,改善胃肠功能,手术安全,疗效肯定。

关键词: 胆囊结石, 慢性胆囊炎, 腹腔镜胆囊切除术, 疗效, 胃泌素, 胃动素, 血管活性肠肽

Abstract: Objective To investigate the efficacy of laparoscopic cholecystectomy (LC) in the treatment of patients with gallstones and chronic cholecystitis.Methods 70 patients with gallstones and chronic cholecystitis were enrolled in our hospital between March 2018 and March 2020, and were randomly divided into control group (n=35) and observation group (n=35). The patients in the control group were treated with open cholecystectomy with small incision, and those in the observation group were treated with LC. Serum gastrin (GAS), vactive intestinal peptide (VIP) and motilin (MOT) levels were detected by ELISA.Results The operationtime in the observation group was (60.6 ±6.5) min, which was significantly shorter than that in the control group [(95.4±7.2) min, P<0.05], the postoperative hospital stay was (5.3±1.4) d, which was significantly shorter than that in the control group [(7.7±2.5) d, P<0.05], and the intraoperative blood loss was (42.3±12.4) mL, which was significantly less than that in the control group [(124.5±21.7) mL, P <0.05]; serum glutamyl transferase (GGT) level in the observation group was (41.4±9.3) U/L, which was significantly lower than in the control group [(65.1±10.5) U/L, P<0.05], serum aspartate aminotransferase (AST) level was (45.3±17.5) U/L, which was significantly lower than in the control group [(71.2±19.7)U/L, P<0.05], and serum alanine aminotransferase (ALT) level was (28.0±20.5) U/L, which was significantly lower than in the control group [ (59.5±22.8) U/L, P<0.05]; serum C-reactive protein (CRP) level was (28.4±8.3) ng/L, which was significantly lower than in the control group [(35.7±8.7) ng/L, P<0.05], serum interleukin-6 (IL-6) level was (42.4±5.3) ng/L, which was significantly lower than that in the control group [(47.7±6.7) ng/L, P<0.05], serum tumor necrosis factor-ɑ (TNF-ɑ) level was (1.9±0.5) μg/L, which was significantly lower than that in the control group [(4.7±0.9) μg/L, P<0.05]; serum GAS level was (129.5±12.4) ng/L, which was significantly higher than that in the control group [(112.7±10.6) ng/L, P<0.05], serum MOT level was (242.4±38.7) ng/L, which was significantly higher than that in the control group [(197.6±42.4) ng/L, P<0.05], and serum VIP level was (18.2±3.7) pg/mL, which was significantly lower than that in the control group [(22.8±5.3) pg/mL, P<0.05]; after operation, the incidence of complications in the observation group was 8.6%, significantly lower than that in the control group (20.0%, P<0.05).Conclusion The application of laparoscopic cholecystectomy for treatment of patients with gallstones and chronic cholecystitis is efficacious, which might significantly decrease serum VIP level and increase serum GAS and MOT levels, improve gastrointestinal function restoration, and relieve inflammation reaction.

Key words: Gallstones, Chronic cholecystitis, Laparoscopic cholecystectomy, Efficacy, Gastrin, motilin, Vasoactive intestinal peptide

罗登, 赖习华, 刘首记. 腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎患者治疗效果分析[J]. 实用肝脏病杂志, 2021, 24(2): 276-279.

Luo Deng, Lai Xihua, Liu Shouji. Efficacyof laparoscopic cholecystectomy in the treatment of patients with gallstones and chronic cholecystitis[J]. Journal of Practical Hepatology, 2021, 24(2): 276-279.

参考文献

[1] 赵登科, 赵彩霞. 疏肝利胆通泄法联合熊去氧胆酸治疗胆结石合并慢性胆囊炎患者疗效初步研究. 实用肝脏病杂志, 2017, 20(5): 633-634.
[2] Lord A C, Hicks G, Pearce B, et al. Safety and outcomes of laparoscopic cholecystectomy in the extremely elderly: a systematic review and meta-analysis. Acta Chir Belg, 2019, 119(6): 349-356.
[3] Tebala G D, Belvedere A, Keane S, et al. Day-case laparoscopic cholecystectomy: analysis of the factors allowing early discharge. Updates Surg, 2017, 69(4): 461-469.
[4] E in S, Yeşiltaş M, Gökçek B, et al. Early laparoscopic cholecystectomy following acute biliary pancreatitis expedites recovery. Ulus Travma Acil Cerrahi Derg, 2017, 23(6): 495-500.
[5] Strasberg S M, Brunt L M. The critical view of safety: why it is not the only method of ductal identification within the standard of care in laparoscopic cholecystectomy. Ann Surg, 2017, 265(3): 464-465.
[6] Bangash M, Alvi A R, Shahzad N, et al. Factors associated with premalignant epithelial changes in chronic calculous cholecystitis: a case-control study. World J Surg, 2018, 42(6): 1701-1705.
[7] 俞阳, 陈中皓, 廖作富, 等. 腹腔镜胆囊切除术治疗酒精性肝硬化合并胆囊结石患者临床疗效及其并发症相关危险因素分析. 实用肝脏病杂志, 2018, 21(3): 364-367.
[8] Arslan Onuk Z A, Gündüz U R, Koç Ü, et al. Same-admission laparoscopic cholecystectomy in acute cholecystitis: the importance of 72 hours and oxidative stress markers. Ulus Travma Acil Cerrahi Derg, 2019, 25(5): 440-446.
[9] Gomez D, Cox M R. Laparoscopic transcystic stenting and postoperative ERCP for the management of common bile duct stones at laparoscopic cholecystectomy. Ann Surg, 2018, 267(5): 86-88.
[10] Fuertes-Guirò F, Girabent-Farrés M. Higher cost of single incision laparoscopic cholecystectomy due to longer operating time. a study of opportunity cost based on meta-analysis. G Chir, 2018, 39(1): 24-34.
[11] Feng Y, Wong C, Park A, et al. Taxonomy of instructions given to residents in laparoscopic cholecystectomy. Surg Endosc, 2016, 30(3): 1073-7.
[12] 牛四明. 不同Calot三角解剖入路腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎患者疗效对比分析. 实用肝脏病杂志, 2018, 21(3): 447-450.
[13] Torney M, Aghlmandi S, Zeindler J, et al. High-resolution standardization reduces delay due to workflow disruptions in laparoscopic cholecystectomy. Surg Endosc, 2018, 32(12): 4763-4771.
[14] Stavrou G, Fotiadis K, Panagiotou D, et al. Homemade specimen retrieval bag for laparoscopic cholecystectomy: a solution in the time of fiscal crisis. Asian J Endosc Surg, 2015, 8(2): 223-225.
[15] Angelou A, Skarmoutsos A, Margonis G A, et al. Robotic single port cholecystectomy: current data and future perspectives. Minerva Chir, 2017, 72(2): 140-145.
[16] 鲁德斌, 刘西平, 胡林忠. 腹腔镜胆囊切除术与开腹胆囊切除术治疗胆囊结石患者外周血淋巴细胞和细胞因子水平的变化. 实用肝脏病杂志, 2016, 19(3): 335-338.
[17] Olariu S. The evolution of concepts in laparoscopic cholecystectomy in a general surgical clinic from timisoara, romania. Ann Ital Chir, 2015, 86(2): 126-131.
[18] Bangash M, Alvi AR, Shahzad N, et al. Factors associated with premalignant epithelial changes in chronic calculous cholecystitis: a case-control study. World J Surg, 2018, 42(6): 1701-1705.
[19] Bartnicka J, Zietkiewicz A A, Kowalski G J, et al. Advantages and disadvantages of 1-incision, 2-incision, 3-incision, and 4-incision laparoscopic cholecystectomy: a workflow comparison study. Surg Laparosc Endosc Percutan Tech, 2016, 26(4): 313-318.
[20] Della Penna A, Lange J, Hilbert J, et al. Ursodeoxycholic acid for 6 months after bariatric surgery is impacting gallstone associated morbidity in patients with preoperative asymptomatic gallstones. Obes Surg, 2019, 29(4): 1216-1221.