两术式联合治疗急性胆囊炎对术后胃肠功能及应激反应指标水平的影响观察

陈海洋; 李俊川

doi:10.13201/j.issn.1009-5918.2021.07.007

两术式联合治疗急性胆囊炎对术后胃肠功能及应激反应指标水平的影响观察

陈海洋,
李俊川^,

- 资阳市第一人民医院普外科(四川资阳, 641300)
基金项目:
四川省医学科研课题(No:S17083)

详细信息

通讯作者: 李俊川,E-mail:diekrjg223@163.com

中图分类号: R657.4

收稿日期: 2021-03-16

Observation on effects of combination of two surgical methods on postoperative gastrointestinal function and levels of stress response indicators in the treatment of acute cholecystitis

CHEN Haiyang,
LI Junchuan^,

- Department of Surgery, the First People's Hospital of Ziyang, Ziyang, Sichuan, 641300, China

More Information

Corresponding author: LI Junchuan, E-mail: diekrjg223@163.com

Received Date: 16 March 2021

摘要

摘要: 目的:探究两术式联合治疗急性胆囊炎(AC)对术后胃肠功能及应激反应指标水平的影响。方法:回顾性分析96例AC患者资料,以手术方案的差异为分组标准分为LC组(腹腔镜胆囊切除术)45例和PTGD+LC组(经皮经肝胆囊穿刺置管引流术+腹腔镜胆囊切除术)51例,比较两组患者手术情况和住院时间、胃肠功能、应激反应指标、炎症和免疫指标、并发症差异。结果:PTGD+LC组患者手术时间、术后住院时间长于LC组(P<0.05),术中出血量少于LC组(P<0.05),两组患者术中中转开腹率差异无统计学意义(P>0.05);PTGD+LC组患者术后肠鸣音恢复时间、肛门排气时间、排便时间及首次耐受固体食物时间均短于LC组(P<0.05);术后72 h内,两组患者促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、皮质醇(Cor)水平先升后降(P<0.05),且PTGD+LC组患者术后24 h、72 h的ACTH、NE、Cor水平低于LC组(P<0.05);术后7 d,两组患者炎症指标[白细胞介素-2(IL-2)、IL-6、超敏C反应蛋白(hs-CRP)]水平升高(P<0.05),免疫指标[T淋巴细胞亚群(CD3⁺、CD4⁺、CD4⁺/CD8⁺)]水平降低(P<0.05),但PTGD+LC组患者炎症指标水平低于LC组(P<0.05),免疫指标水平高于LC组(P<0.05);PTGD+LC组患者术后并发症发生率低于LC组(P<0.05)。结论:相较于LC,AC患者行PTGD+LC术式治疗虽延长了手术时间与住院时间,但更有助于促进术后胃肠功能恢复、减轻机体应激反应和炎症反应,免疫抑制更轻,有利于降低并发症风险。
- 联合术式 /
- 急性胆囊炎 /
- 胃肠功能 /
- 应激反应
Abstract: Objective: To explore the effects of combination of two surgical methods on postoperative gastrointestinal function and levels of stress response indicators in the treatment of acute cholecystitis(AC).Methods: The data of 96 patients with AC were retrospectively analyzed. The patients were divided into LC group(laparoscopic cholecystectomy, 45 cases) and PTGD+LC group(percutaneous transhepatic gallbladder drainage + laparoscopic cholecystectomy, 51 cases) based on the differences in surgical methods. The surgical status and hospital stay, gastrointestinal function, stress response indicators, inflammatory indicators and immune indicators and complications were compared between the two groups.Results: The surgical time and postoperative hospital stay in PTGD+LC group were longer than those in LC group(P<0.05), and the amount of intraoperative blood loss was less than that in LC group(P<0.05), and there was no significant difference in the intraoperative conversion rate to laparotomy between the two groups(P>0.05). The postoperative bowel sound recovery time, anal exhaust time, defecation time and first tolerance time of solid food in PTGD+LC group were shorter than those in LC group(P<0.05). Within 72 h after surgery, the levels of adrenocorticotropic hormone(ACTH), norepinephrine(NE), and cortisol(Cor) in the two groups were increased first and then decreased(P<0.05), and the levels of ACTH, NE and Cor in PTGD+LC group were lower than those in LC group at 24 h and 72 h after surgery(P<0.05). At 7 d after surgery, the levels of inflammatory indicators[interleukin-2(IL-2), IL-6, and high-sensitivity C-reactive protein(hs-CRP) ]were increased in the two groups(P<0.05) while the levels of immune indicators[T lymphocyte subsets(CD3⁺, CD4⁺, CD4⁺/CD8⁺) ]were decreased(P<0.05), but the levels of inflammatory indicators in PTGD+LC group were lower than those in LC group(P<0.05) while the levels of immune indicators were higher than those in LC group(P<0.05). The incidence rate of postoperative complications in PTGD+LC group was lower than that in LC group(P<0.05).Conclusion: Compared with LC, PTGD+LC surgical treatment for patients with AC may prolong the surgical time and hospital stay, but it is more helpful to promote the recovery of postoperative gastrointestinal function, and relieve the body's stress response and inflammatory response, and it has milder immunosuppression and can help reduce the risk of complications.
- combination of surgical methods /
- acute cholecystitis /
- gastrointestinal function /
- stress response

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参考文献(19)

[1]	张毅明,偰光华.老年急性胆囊炎发病特点及治疗效果[J].中国老年学杂志,2018,38(20):4927-4929.
[2]	王宏,寻权,杨明,等.急性胆囊炎的外科治疗方法比较分析[J].中华普通外科杂志,2017,32(2):141-144.
[3]	Yokoe M,Takada T,Strasberg SM,et al.TG13 diagnostic criteria and severity grading of acute cholecystitis(with videos)[J].J Hepatobiliary Pancreat Sci,2013,20(1):35-46.
[4]	杨明,张学军.经皮肝胆囊穿刺引流在急性胆囊炎治疗中应用进展[J].中国实用外科杂志,2019,39(3):280-282.
[5]	耿新,彭慈军,冯赞杰,等.中度急性胆囊炎的临床诊治进展[J].中华普通外科杂志,2019,34(8):739-741.
[6]	程廷涛,丁钧.PTCD联合腹腔镜胆囊切除术治疗急性胆囊炎患者的疗效分析[J].重庆医学,2019,48(6):1058-1061.
[7]	张志鹏,谭石,凌晓锋,等.超声引导下经皮经肝胆囊穿刺引流治疗高手术风险急性胆囊炎[J].中国微创外科杂志,2018,18(7):590-593.
[8]	何苑棉.糖皮质激素联合目标液体复苏法对脓毒症休克患儿组织灌注指标、免疫功能及乳酸清除率的影响[J].中南医学科学杂志,2018,46(2):176-179.
[9]	王洪波,王鹏远,汪欣,等.预测急性胆囊炎保守治疗无效的早期危险因素[J].中华急诊医学杂志,2019,28(5):630-633.
[10]	王越市.急性胆囊炎引流治疗的进展[J].中国微创外科杂志,2018,18(2):159-162.
[11]	徐立新,郑建瑞,邓彩杰,等.腹腔镜胆囊切除术对有既往上腹部手术史患者术后免疫功能的影响[J].中国临床实用医学,2019,10(2):46-48.
[12]	闫峥峥,贺杰峰,邢君.经皮经肝胆囊穿刺置管引流术后早期和延期腹腔镜胆囊切除术在年龄≥65岁急性重症胆囊炎患者中应用价值的前瞻性研究[J].中华消化外科杂志,2019,18(5):447-452.
[13]	黄洁,任拾璞,杨理雯.超声引导下经皮经肝胆囊穿刺引流术治疗急性胆囊炎的临床效果[J].临床肝胆病杂志,2017,33(2):286-288.
[14]	柯昌伟,吴硕东,李勇男.中度急性胆囊炎行急诊胆囊切除与经皮经肝胆囊穿刺引流术加择期胆囊切除的疗效对比分析[J].中华医学杂志,2018,98(10):768-772.
[15]	李冰震,王理富,马柏强,等.老年急性胆囊炎患者腹腔镜术后胃肠功能恢复、炎症因子和应激反应的变化[J].中国老年学杂志,2018,38(13):3158-3160.
[16]	席广利,董浩.腹腔镜胆囊切除术治疗急性胆囊炎的效果及预后[J].临床肝胆病杂志,2018,34(2):332-336.
[17]	王和彪,陶攀,夏幸.胆囊穿刺引流与胆囊造瘘在治疗急性非结石性胆囊炎合并急性腹膜炎中的比较研究[J].贵州医药,2020,44(3):396-398.
[18]	李永贵.经皮经肝胆囊穿刺引流术联合腹腔镜胆囊切除术治疗急性危重胆囊炎的短期疗效及对患者免疫功能的影响[J].中国老年学杂志,2017,37(23):5898-5900.
[19]	田文玲.腹腔镜胆囊切除术与开腹胆囊切除术对机体应激及免疫功能的影响[J].山东医药,2015,55(29):74-75.