经胆囊后三角入路和经胆囊三角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及对血清炎症因子的影响*

doi:10.3969/j.issn.1672-5069.2023.04.032

摘要/Abstract

摘要： 目的探讨经胆囊后三角入路与经胆囊三角入路行腹腔镜胆囊切除术(LC)治疗胆囊结石伴慢性胆囊炎患者的疗效及对血清炎症因子水平的影响。方法 2018年1月～2022年12月我院收治的62例胆囊结石伴慢性胆囊炎患者,被随机分为观察组和对照组,每组31例,分别采取经胆囊后三角入路或经胆囊三角入路行LC术。采用ELISA法检测C-反应蛋白(CRP)、肿瘤坏死因子(TNF-α)和白介素-8(IL-8)水平,使用流式细胞仪检测外周血淋巴细胞亚群。结果观察组手术时间、术中出血量、胃肠道功能恢复时间和住院日分别为(27.5±2.4)min、(27.8±4.3)mL、(20.4±3.2)h和(3.9±0.9)d,显著短于或少于对照组【分别为(32.9±3.8)min、(40.6±6.5)mL、(27.9±4.5)h和(6.2±1.5)d,P＜0.05】;在术后3 d,观察组血清CRP、TNF-α和IL-8水平分别为(32.7±2.5)mg/L、(16.4±2.6)ng/L和(11.2±2.5)ng/L,均显著低于对照组【分别为(44.5±3.9)mg/L、(20.6±2.9)ng/L和(16.8±2.7)ng/L,P＜0.05】;观察组外周血CD4⁺和CD8⁺细胞百分比及CD4⁺/CD8⁺细胞比值分别为(50.6±2.3)%、(25.6±3.7)%和(1.9±0.6),与对照组【分别为(51.2±2.7)%、(26.1±3.4)%和(1.9±0.8)】比,无显著性差异(P>0.05);观察组术中中转开腹和术后皮下气肿、胆漏、胆管损伤、动脉损伤等并发症发生率为9.7%,显著低于对照组的32.3%(P＜0.05)。结论经胆囊后三角入路行LC手术治疗胆囊结石伴慢性胆囊炎患者更有利于手术的开展,减少并发症发生,可能与手术操作顺利,降低了应激反应有关。

关键词: 胆囊结石, 慢性胆囊炎, 经胆囊后三角入路, 腹腔镜胆囊切除术, 应激反应, 治疗

Abstract: Objective The aim of this study was to compare the advantages of gallbladder posterior triangle approach (GPTA) to triangle approach (TA) during laparoscopic cholecystectomy (LC) in treatment of patients with gallbladder stones and chronic cholecystitis (CC). Methods 62 patients with gallbladder stones and CC were admitted to our hospital between January 2018 and December 2022, and were randomly divided into observation and control group, with 31 cases in each group. The patients in the observation received LC through GPTA, and those through TA. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) levels were detected by ELISA, and the percentages of peripheral blood lymphocyte subsets were detected by flow cytometry. Results The operation time, intraoperative blood loss, recovery time of gastrointestinal functions and post-operational hospitalization stay in the observation group were(27.5±2.4)min, (27.8±4.3)mL, (20.4±3.2)h and (3.9±0.9)d, all significantly less or shorter than [(32.9±3.8)min, (40.6±6.5)mL, (27.9±4.5)h and (6.2±1.5)d, respectively, P＜0.05] in the control; at day three post-operationally, serum CRP, TNF-α and IL-8 levels in the observation group were (32.7±2.5)mg/L,(16.4±2.6)ng/L and (11.2±2.5)ng/L, all much lower than [(44.5±3.9)mg/L, (20.6±2.9)ng/L and (16.8±2.7)ng/L, respectively, P＜0.05] in the control; the percentages of peripheral blood CD4⁺ and CD8⁺ cells as well as the CD4⁺/CD8⁺ cell ratio in the observation were (50.6±2.3)%,(25.6±3.7)% and (1.9±0.6), not significantly different compared to [(51.2±2.7)%, (26.1±3.4)% and (1.9±0.8)] in the control group (P>0.05); post-operationally, the incidences of complications, such as bile leak and/or bile duct injury, in the observation group was 9.7%, much lower than 32.3%(P＜0.05) in the control. Conclusion The GPTA during LC in treatment of patients with cholecystolithiasis and CC is superior to TA, which might be related to relatively easy manipulation and less complications.

Key words: Cholecystolithiasis, Chronic cholecystitis, Laparoscopic cholecystectomy, Through gallbladder posterior triangle approach, Through gallbladder triangle approach, Reactive response, Therapy

郑峰, 李彦荣, 罗卫军, 张晓超. 经胆囊后三角入路和经胆囊三角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及对血清炎症因子的影响^*[J]. 实用肝脏病杂志, 2023, 26(4): 580-583.

Zheng Feng, Li Yanrong, Luo Weijun, et al. Is the gallbladder posterior triangle approach superior to triangle approach during laparoscopic cholecystectomy in treatment of patients with gallbladder stones and chronic cholecystitis?[J]. Journal of Practical Hepatology, 2023, 26(4): 580-583.

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经胆囊后三角入路和经胆囊三角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及对血清炎症因子的影响^*

Is the gallbladder posterior triangle approach superior to triangle approach during laparoscopic cholecystectomy in treatment of patients with gallbladder stones and chronic cholecystitis?

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