腹腔镜胆囊切除术治疗急性结石性胆囊炎对应激反应、免疫功能和胃肠功能的影响(1)
【摘要】 目的：探讨腹腔镜胆囊切除术(LC)治疗急性结石性胆囊炎(ACC)对应激反应、免疫功能和胃肠功能的影响。方法：将2016年1月-2018年4月于本院就诊的78例ACC患者纳入研究，按照随机数字表法分组，对照组39例行传统开腹胆囊切除术(OC)，观察组39例行LC。比较两组手术前后内皮素(ET)、白细胞(WBC)、超敏C反应蛋白(hs-CRP)、胃肠功能恢复时间、T细胞因子CD3+、CD4+、CD8+。结果：手术1 d后两组ET、WBC、hs-CRP均增加，观察组应激指标均优于对照组(P<0.05);手术1 d后两组CD3+、CD4+、CD8+均下降，且观察组均高于对照组，差异均有统计学意义(P<0.05);与对照组相比，观察组治疗后胃肠功能恢复更快，差异均有统计学意义(P<0.05)。结论：腹腔镜胆囊切除术治疗急性结石性胆囊炎的临床疗效突出，能对应激反应、免疫功能、胃肠功能产生积极影响，适合临床推广与应用。
【关键词】 腹腔镜胆囊切除术; 急性结石性胆囊炎; 应激反应; 免疫功能; 胃肠功能
【Abstract】 Objective：To investigate the effect on stress response，immune function and gastrointestinal function of laparoscopic cholecystectomy(LC)in the treatment of acute calculous cholecystitis(ACC).Method：A total of 78 patients with ACC from January 2016 to April 2018 were enrolled in the study.They were randomly divided into two groups，the control group(39 cases)treated with traditional open cholecystectomy(OC)and the observation group(39 cases)treated with LC.Endothelin(ET)，leukocyte(WBC)，high-sensitivity C-reactive protein(hs-CRP)，gastrointestinal function recovery time，T-cell factors CD3+，CD4+ and CD8+ were compared between two groups before and after operation.Result：1 d after surgery，ET，WBC，hs-CRP increased in two groups，the stress indexes in the observation group were better than those in the control group(P<0.05).1 d after surgery，CD3+，CD4+，CD8+ decreased in two groups，and the immune indexes in the observation group were better(P<0.05).Compared with the control group，the gastrointestinal function in the observation group recovered faster，the difference was significant(P<0.05).Conclusion：Laparoscopic cholecystectomy in the treatment of acute calculous cholecystitis has a prominent clinical efficacy，which have a positive impact on stress response，immune function，gastrointestinal function，and is suitable for clinical promotion and application.
【Key words】 Laparoscopic cholecystectomy; Acute calculous cholecystitis; Stress response; Immune function; Gastrointestinal function
First-author’s address：Xinyu Hospital of Traditional Chinese Medicine，Xinyu 338000，China
doi：10.3969/j.issn.1674-4985.2019.03.027
急性結石性胆囊炎(acute calculouscholecysti-tis，ACC)是一类常见的肝胆外科疾病。发病机制是结石阻塞胆囊管，引起胆汁在胆囊内的滞留，造成致病菌入侵，引发急性炎症反应[1]。ACC好发于中老年女性，具有发病率高、复发率高、病情严重、发展迅猛等特点，临床表现为上腹疼痛、恶心、呕吐、发热等[2]。目前针对该病以手术治疗为主，传统的开腹胆囊切除术(OC)因痛苦多、并发症复杂等弊端，影响术后康复;而随着医疗技术的不断革新，腹腔镜胆囊切除术(LC)凭借其创伤小、安全性高、并发症少、恢复时间短等优势，在ACC领域备受关注，应用越来越广[3-4]。因此本研究选用LC治疗ACC，并与OC组进行应激反应、免疫功能和胃肠功能指标比较，来评价疗效和预后，有着一定的临床意义。现报道如下。, 百拇医药(夏侯海峰 丁根华 赖小军)
【关键词】 腹腔镜胆囊切除术; 急性结石性胆囊炎; 应激反应; 免疫功能; 胃肠功能
【Abstract】 Objective：To investigate the effect on stress response，immune function and gastrointestinal function of laparoscopic cholecystectomy(LC)in the treatment of acute calculous cholecystitis(ACC).Method：A total of 78 patients with ACC from January 2016 to April 2018 were enrolled in the study.They were randomly divided into two groups，the control group(39 cases)treated with traditional open cholecystectomy(OC)and the observation group(39 cases)treated with LC.Endothelin(ET)，leukocyte(WBC)，high-sensitivity C-reactive protein(hs-CRP)，gastrointestinal function recovery time，T-cell factors CD3+，CD4+ and CD8+ were compared between two groups before and after operation.Result：1 d after surgery，ET，WBC，hs-CRP increased in two groups，the stress indexes in the observation group were better than those in the control group(P<0.05).1 d after surgery，CD3+，CD4+，CD8+ decreased in two groups，and the immune indexes in the observation group were better(P<0.05).Compared with the control group，the gastrointestinal function in the observation group recovered faster，the difference was significant(P<0.05).Conclusion：Laparoscopic cholecystectomy in the treatment of acute calculous cholecystitis has a prominent clinical efficacy，which have a positive impact on stress response，immune function，gastrointestinal function，and is suitable for clinical promotion and application.
【Key words】 Laparoscopic cholecystectomy; Acute calculous cholecystitis; Stress response; Immune function; Gastrointestinal function
First-author’s address：Xinyu Hospital of Traditional Chinese Medicine，Xinyu 338000，China
doi：10.3969/j.issn.1674-4985.2019.03.027
急性結石性胆囊炎(acute calculouscholecysti-tis，ACC)是一类常见的肝胆外科疾病。发病机制是结石阻塞胆囊管，引起胆汁在胆囊内的滞留，造成致病菌入侵，引发急性炎症反应[1]。ACC好发于中老年女性，具有发病率高、复发率高、病情严重、发展迅猛等特点，临床表现为上腹疼痛、恶心、呕吐、发热等[2]。目前针对该病以手术治疗为主，传统的开腹胆囊切除术(OC)因痛苦多、并发症复杂等弊端，影响术后康复;而随着医疗技术的不断革新，腹腔镜胆囊切除术(LC)凭借其创伤小、安全性高、并发症少、恢复时间短等优势，在ACC领域备受关注，应用越来越广[3-4]。因此本研究选用LC治疗ACC，并与OC组进行应激反应、免疫功能和胃肠功能指标比较，来评价疗效和预后，有着一定的临床意义。现报道如下。, 百拇医药(夏侯海峰 丁根华 赖小军)