加速康复外科联合单孔腹腔镜胆囊切除术的效果与安全性研究

Effect and safety of enhanced recovery after surgery combined with single port laparoscopic cholecystectomy

摘要:

目的 探讨加速康复外科（ERAS）联合单孔腹腔镜胆囊切除术（LC）的治疗效果与安全性。方法 选取2020年12月－2021年11月该院行LC的患者120例，按随机数表法分为两组，每组60例，两组患者均采用ERAS理念处理。其中，对照组采取四孔法，观察组采取单孔法。比较两组患者手术相关指标、不同时点视觉模拟评分（VAS）变化、血清髓过氧化物酶（MPO）、白细胞介素-1（IL-1）、免疫球蛋白A（IgA）、免疫球蛋白M（IgM）和免疫球蛋白G（IgG）水平，以及并发症发生率和随访结果。结果 观察组手术时间较对照组长，术中出血量较对照组少，术后排气时间和住院时间短于对照组，住院费用多于对照组，术后12和24 h VAS低于对照组，术后1、3和7 d血清IgA、IgG和IgM水平高于对照组，术后1、3和7 d血清IL-1和MPO水平低于对照组，并发症发生率低于对照组（10.00%和25.00%），术后1个月胃肠道疾病生存质量指数（GIQLI）和腹壁美容满意度高于对照组，差异均有统计学意义（P < 0.05）。结论 ERAS联合单孔LC，可减轻患者应激反应，减少对机体免疫力的影响，减少术后并发症，缩短住院时间，且脐部褶皱处切口隐蔽，美容效果好，安全性高。

Abstract:

Objective To investigate the effect and safety of enhanced recovery after surgery (ERAS) combined with single-port laparoscopic cholecystectomy (LC).Methods 120 patients who underwent LC from December 2020 to November 2021 were selected and randomly divided into two groups, 60 cases in each group. Both groups were treated with ERAS concept, the control group was treated with four-port LC, and the observation group was treated with single-port LC. Comparison of surgical indicators and postoperative recovery, changes in pain visual analogue scale (VAS) at different time points, serum myeloperoxidase (MPO), interleukin-1 (IL-1), immunoglobulin A (IgA), immunoglobulin M (IgM), immunoglobulin G (IgG) levels, complications and follow-up results.Results The operation time in the observation group was longer than that in the control group, the intraoperative blood loss less than that in the control group, the postoperative exhaust gas and hospitalization time were shorter than those in the control group, total hospitalization expenses was more than that in the control group, the VAS of the observation group at 12 and 24 h after operation were lower than those of the control group, the serum levels of IgA, IgG and IgM in the observation group at 1, 3 and 7 d after operation were higher than those in the control group, the levels of serum IL-1 and MPO in the observation group at 1, 3 and 7 d after operation were lower than those in the control group, the complication rate of the observation group was lower than that of the control group (10.00% and 25.00%), the gastrointestinal quality of life index (GIQLI) and abdominal wall cosmetic satisfaction of the observation group at 1 month after operation were higher than those of the control group, the differences were statistically significant (P < 0.05).Conclusion ERAS combined with single-port LC can reduce the patient’s stress reaction and the effect on the body’s immunity, which has a positive significance in reducing postoperative complications and shortening the length of hospital stay, as well as the incision at the umbilical fold is hidden, with a good cosmetic effect and a high degree of safety.