腹腔镜胆囊切除术治疗急性结石性胆囊炎合并胆汁性腹膜炎的效果分析(1)
[摘要] 目的 探討腹腔镜胆囊切除术治疗急性结石性胆囊炎合并胆汁性腹膜炎的临床效果。方法 方便选择该院2016年5月—2018年6月收治的急性结石性胆囊炎合并胆汁性腹膜炎患者130例为研究样本，以简单随机法分为参照组和治疗组各65例，参照组采取常规开腹手术治疗，治疗组采取腹腔镜胆囊切除术治疗，观察对比两组手术效果和预后状况。结果 ①手术指标。治疗组术中出血量(79.28±9.12)mL、胃肠功能恢复时间(29.02±6.99)h、住院时间(5.25±1.34)d均低于参照组[术中出血量(160.85±8.24)mL、胃肠功能恢复时间(39.97±8.23)h、住院时间(8.70±1.30)d](t=53.505，8.176，14.898，P=0.000，0.000，0.000，0.000);②炎症因子。治疗组中性粒细胞计数(15.91±2.07)×109/L、CRP(9.22±1.44)mg/L、IL-6(20.11±2.59)pg/mL、TNF-(9.52±3.48)ng/L、ESR(28.12±5.88)mm/h均低于参照组[中性粒细胞计数(22.32±2.18)×109/L、CRP(15.52±2.08)mg/L、IL-6(35.23±3.54)pg/mL、TNF-(13.51±3.49)ng/L、ESR(32.21±6.13)mm/h](t=17.191，20.077，27.791，6.527，3.882，P=0.000，0.000，0.000，0.000，0.000);③预后状况。治疗组并发症发生率4.62%和死亡率1.54%均低于参照组(16.92%，10.77%)(χ2=5.123，4.795，P=0.024，0.029)。 结论 腹腔镜胆囊腔切除术治疗急性结石性胆囊炎合并胆汁性腹膜炎患者有微创优势，且能降低机体炎症反应水平，降低术后并发症风险，促进患者胃肠功能早日恢复，值得临床应用。
[关键词] 急性结石性胆囊炎;胆汁性腹膜炎;腹腔镜胆囊切除术;临床效果分析
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2019)04(a)-0013-04
[Abstract] Objective To investigate the clinical effect of laparoscopic cholecystectomy in the treatment of acute calculouscholecystitis with biliary peritonitis. Methods Convenient selection in our hospital in May 2016 to June 2018 treated acute calculouscholecystitis merger in the sample of 130 patients with bile peritonitis， with simple random method is divided into control group and treatment group 65 cases， control group treated with conventional laparotomy， the treatment group treated with laparoscopic cholecystectomy， observe comparing two groups of surgical effect and prognosis. Results 1.Surgical indicators. The intraoperative blood loss (79.28±9.12) mL， gastrointestinal function recovery time (29.02±6.99) h， and hospitalization time (5.25±1.34) d were lower in the treatment group than in the reference group [intraoperative blood loss (160.85±8.24) mL， Gastrointestinal function recovery time (39.97±8.23) h， hospitalization time (8.70±1.30)d](t=53.505， 8.176， 14.898， P=0.000， 0.000， 0.000， 0.000); 2.inflammatory factors. The neutrophil count (15.91±2.07)×109/L， CRP (9.22±1.44) mg/L， IL-6 (20.11±2.59) pg/mL， TNF-(9.52±3.48) ng/L， ESR (28.12±5.88) mm/h was lower than the reference group [neutrophil count (22.32±2.18)×109/L， CRP (15.52±2.08) mg/L， IL-6 (35.23±3.54) pg/mL， TNF- (13.51±3.49) ng/L， ESR (32.21±6.13) mm/h](t=17.191， 20.077， 27.791， 6.527， 3.882， P=0.000， 0.000， 0.000， 0.000， 0.000); 3.The prognosis. The complication rate of the treatment group was 4.62% and the mortality rate was 1.54%， which was lower than that of the reference group (16.92%， 10.77%)(χ2=5.123， 4.795， P=0.024， 0.029). Conclusion Laparoscopic cholecystectomy for acute calculouscholecystitis complicated with biliary peritonitis has the advantage of minimally invasive， and can reduce the level of inflammation， reduce the risk of postoperative complications， and promote the early recovery of gastrointestinal function， which is worthy of clinical application., 百拇医药(张道建 丰威 陈亚阳 徐志鹏)
[关键词] 急性结石性胆囊炎;胆汁性腹膜炎;腹腔镜胆囊切除术;临床效果分析
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2019)04(a)-0013-04
[Abstract] Objective To investigate the clinical effect of laparoscopic cholecystectomy in the treatment of acute calculouscholecystitis with biliary peritonitis. Methods Convenient selection in our hospital in May 2016 to June 2018 treated acute calculouscholecystitis merger in the sample of 130 patients with bile peritonitis， with simple random method is divided into control group and treatment group 65 cases， control group treated with conventional laparotomy， the treatment group treated with laparoscopic cholecystectomy， observe comparing two groups of surgical effect and prognosis. Results 1.Surgical indicators. The intraoperative blood loss (79.28±9.12) mL， gastrointestinal function recovery time (29.02±6.99) h， and hospitalization time (5.25±1.34) d were lower in the treatment group than in the reference group [intraoperative blood loss (160.85±8.24) mL， Gastrointestinal function recovery time (39.97±8.23) h， hospitalization time (8.70±1.30)d](t=53.505， 8.176， 14.898， P=0.000， 0.000， 0.000， 0.000); 2.inflammatory factors. The neutrophil count (15.91±2.07)×109/L， CRP (9.22±1.44) mg/L， IL-6 (20.11±2.59) pg/mL， TNF-(9.52±3.48) ng/L， ESR (28.12±5.88) mm/h was lower than the reference group [neutrophil count (22.32±2.18)×109/L， CRP (15.52±2.08) mg/L， IL-6 (35.23±3.54) pg/mL， TNF- (13.51±3.49) ng/L， ESR (32.21±6.13) mm/h](t=17.191， 20.077， 27.791， 6.527， 3.882， P=0.000， 0.000， 0.000， 0.000， 0.000); 3.The prognosis. The complication rate of the treatment group was 4.62% and the mortality rate was 1.54%， which was lower than that of the reference group (16.92%， 10.77%)(χ2=5.123， 4.795， P=0.024， 0.029). Conclusion Laparoscopic cholecystectomy for acute calculouscholecystitis complicated with biliary peritonitis has the advantage of minimally invasive， and can reduce the level of inflammation， reduce the risk of postoperative complications， and promote the early recovery of gastrointestinal function， which is worthy of clinical application., 百拇医药(张道建 丰威 陈亚阳 徐志鹏)