腹腔镜胆囊切除术对患者术后粘连的疗效与安全性分析

Efficacy and safety of laparoscopic cholecystectomy for postoperative adhesions in patients

摘要:

目的 探讨腹腔镜胆囊切除术对患者术后粘连的疗效与安全性。方法 回顾性分析2015年3月－2020年7月该院63例行胆囊切除术的患者的临床资料，根据手术方式不同分为对照组（n = 32）和观察组（n = 31）。对照组行开腹胆囊切除术，观察组行腹腔镜胆囊切除术。比较两组患者临床指标、炎症因子水平、并发症及肠粘连发生率。应用Pearson相关系数分析炎症因子与术后粘连的相关性。结果 观察组手术时间、肛门排气时间和肠鸣音恢复时间均短于对照组［（56.7±8.3）和（82.6±9.4）min、（22.5±2.3）和（35.6±4.3）h、（13.2±5.7）和（19.1±6.8）h］，术后疼痛评分低于对照组［（7.6±0.3）和（9.2±0.5）分］（P < 0.05）。术后2 d，观察组血清C反应蛋白（CRP）和降钙素原（PCT）明显低于对照组［（11.3±3.6）和（26.7±6.5）mg/L，（5.5±1.3）和（6.4±2.5）μg/L］（P < 0.05）。观察组并发症发生率明显低于对照组（6.5%和25.0%，P < 0.05）。术后3个月，观察组肠粘连发生率明显低于对照组（12.9%和28.1%，P < 0.05）。术后CRP和PCT水平与肠粘连发生率存在明显正相关。结论 腹腔镜胆囊切除术可明显改善患者临床指标，降低患者炎症因子水平、并发症和肠粘连发生率。

Abstract:

Objective To investigate the efficacy and safety of laparoscopic cholecystectomy for postoperative adhesions in patients.Methods This study is a retrospective study. 63 patients who underwent cholecystectomy from March 2015 to July 2020 were divided into control group (n = 32) and observation group (n = 31) according to different surgical methods. The control group received open cholecystectomy and the observation group received laparoscopic cholecystectomy. The clinical indexes, the level of inflammatory factors, complications and the incidence of intestinal adhesion were compared between the two groups. The correlation between inflammatory factors and postoperative adhesions was analyzed by Pearson Correlation Coefficient.Results The operation time, anal exhaust time, and bowel sound time in the observation group were significantly lower than those in the control group [(56.7 ± 8.3) min and (82.6 ± 9.4) min, (22.5 ± 2.3) h and (35.6 ± 4.3) h, (13.2 ± 5.7) h and (19.1 ± 6.8) h], and the postoperative pain score was significantly lower than that in the control group [(7.6 ± 0.3) and (9.2 ± 0.5)] (P < 0.05). Two days after operation, serum C-reaction protein (CRP) and procalcitonin (PCT) in the observation group were significantly lower than those in the control group [(11.3 ± 3.6) mg/L and (26.7 ± 6.5) mg/L, (5.5 ± 1.3) μg/L and (6.4 ± 2.5) μg/L] (P < 0.05). The incidence of complications in the observation group was significantly lower than that in the control group (6.5% and 25.0%) (P < 0.05). 3 months after operation, the incidence of intestinal adhesions in the observation group was significantly lower than that in the control group (12.9% and 28.1%) (P < 0.05). Postoperative CRP and PCT levels were significantly correlated with the incidence of intestinal adhesion.Conclusion Laparoscopic cholecystectomy can significantly improve the clinical indicators, and reduce the levels of inflammatory factors in patients, the incidence of complications and intestinal adhesions.