摘要
目的:探究超声引导下经皮经肝胆囊穿刺引流术(Percutaneous transhepatic gall bladder drainage,PTGBD)序贯腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)对急性胆囊炎(Acute cholecystitis,AC)患者康复效果、炎性应激、创伤应激的影响。方法:收集我院2020年3月至2022年3月收治的130例AC患者,按手术方案不同,分为序贯治疗组、LC术组,各65例。LC术组接受单纯LC术治疗,序贯治疗组先行超声引导下PTGBD术,后行LC术治疗。术后3 d,采用全自动生化分析仪测定患者血清谷草转氨酶(Aspartate aminotransferase,AST)、总胆红素、谷丙转氨酶(Alanine aminotransferase,ALT)水平;术后1 d,采用酶联免疫法测定患者C反应蛋白(C-reactive protein,CRP)、白细胞介素-1(Interleukin-1,IL-1)、白细胞介素-10(Interleukin-10,IL-10)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α),采用全自动生化分析仪检测白细胞计数水平,采用放射免疫法测定患者游离三碘甲状腺原氨酸(Free triiodothyronine,FT3)、游离甲状腺素(Free thyroxine,FT4)水平;比较两组围术期指标和并发症发生情况。结果:序贯治疗组术中总出血量少于LC术组,肛门首次排气时间、手术用时、白细胞恢复时间短于LC术组(P<0.05);术后3 d,序贯治疗组AST、ALT水平高于LC术组,总胆红素低于LC术组(P<0.05);术后1 d,序贯治疗组血清CRP、IL-1、IL-10、TNF-α、白细胞计数、FT3、FT4水平均低于LC术组(P<0.05);序贯治疗组并发症总发生率低于LC术组(P<0.05)。结论:超声引导下PTGBD术序贯LC术治疗AC可优化围术期指标及肝功能指标,减少并发症发生,减轻炎性应激及创伤应激。
Objective:To investigate the effect of ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGBD)sequential laparoscopic cholecystectomy(LC)on the rehabilitation,inflammatory stress,and traumatic stress of patients with acute cholecystitis(AC).Methods:One hundred and thirty patients with AC admitted to our hospital from March 2020 to March 2022 were collected and divided into the sequential treatment group and LC operation group,with 65 patients in each group.LC group was treated by LC alone,while the sequential treatment group received PTGBD under ultrasound guidance first,and then LC.After 3 days of operation,the serum levels of aspartate aminotransferase(AST),total bilirubin,alanine aminotransferase(ALT)were measured by the automatic biochemical analyzer.After 1 day of operation,C-reactive protein(CRP),interleukin-1(IL-1),interleukin-10(IL-10),and tumor necrosis factor-α(TNF-α)were measured by enzyme-linked immunosorbent assay,white blood cell count was measured by the automatic biochemical analyzer,the levels of free triiodothyronine(FT3),and free thyroxine(FT4)were measured by radioimmunoassay,the perioperative indexes and complications were compared between the two groups.Results:The total bleeding volume in the sequential therapy group was less than that in the LC group,and the first anal exhaust time,operation time,and leukocyte recovery time in the sequential treatment group were shorter than those in the LC operation group(P<0.05).After 3 days of operation,the serum levels of AST and ALT in the sequential treatment group were higher than those in the LC operation group,while the serum level of total bilirubin was lower than that in the LC operation group(P<0.05),after 1 day of operation,serum levels of CRP,IL-1,IL-10,TNF-α,leukocyte count,FT3 and FT4 in the sequential treatment group were lower than those in the LC operation group(P<0.05),the total incidence of complications in the sequential treatment group was lower than that in the LC operation group(P<0.05).Conclusion:Ultrasound-guid
作者
尚冬冬
刘现立
范永刚
Shang Dong-dong;Liu Xian-li;Fan Yong-gang(Department of General Surgery,Xin'an Hospital of Traditional Chinese Medicine,Luoyang 471800,Henan,China;Department of General Surgery,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,Henan,China;Department of Hepatobiliary and Pancreatic Surgery,The First Affiliated Hospital of Henan University of Science and Technology(Kaiyuan Hospital Area),Luoyang 471000,Henan,China)
出处
《四川生理科学杂志》
2023年第6期972-975,共4页
Sichuan Journal of Physiological Sciences
关键词
急性胆囊炎
经皮经肝胆囊穿刺引流术
腹腔镜胆囊切除术
创伤应激
炎性应激
Acute cholecystitis
Percutaneous transhepatic gallbladder drainage
Laparoscopic cholecystectomy
Traumatic stress
Inflammatory stress
