微创手术治疗肝硬化合并胆囊结石患者的临床效果及安全性

摘要

Objective To observe the clinical effect of minimally invasive surgery in the treatment of liver cirrhosis patients complicated with gallbladder stone. Methods Total of 127 liver cirrhosis patients complicated with gallbladder stone in our hospital from April 2013 to May 2015 were selected and divided into minimally invasive group (65 cases) and control group (62 cases). Patients in minimally invasive group were treated with minimally invasive laparoscopic surgery, and patients in control group were given traditional laparotomy. The general indexes, immune indexes and biochemical indexes of patients were observed and compared. Results The amount of bleeding [(165.83 ± 50.18) ml], operation time [(91.87 ± 22.64) min], daily drainage [(274.40 ± 121.17) ml], drainage time [(2.37 ± 1.45) d], postoperative exhaust time [(1.32 ± 0.84) d], hospitalization time [(8.34 ± 1.25) d] of patients in minimally invasive group were lower than those in control group (P <0.05). Three days after operation, the level of CD4 [(39.40 ± 2.76)%], CD8 ((24.34 + 2.45)%) and CD4/CD8 (1.44 ± 0.23) of patients in minimally invasive group were better than the those in control group (P < 0.01); the level of TBil, ALT and PT in in minimally invasive group were (18.91 ± 4.97)μmol/L, (48.63 ± 5.75)U/L and (15.55 ± 1.16) s, respectively, and which in control group were (20.33 ± 6.26) μmol/L, (50.25 ± 5.07) U/L and (15.19 ± 1.24) s, respectively, the differences were not statistically significant (P > 0.05). The incidence of complications in minimally invasive group was 9.23% and in control group was 48.39%, the difference was statistically significant (χ2 = 23.7649. P < 0.001). Conclusion Minimally invasive surgery is a kind of effective method in the treatment of liver cirrhosis complicated with gallbladder stone,and it is less invasive and has little effect on liver function.%目的 观察微创手术治疗肝硬化合并胆囊结石患者的临床效果以及安全性.方法 选取2013年4月至2015年5月于本院进行治疗的127例肝硬化合并胆囊结石的患者为研究对象,根据不同治疗措施分为微创组(65例)和对照组(62例),微创组给予腹腔镜微创手术切除胆囊,对照组采取传统开腹术切除胆囊.观察比较术中及术后患者的一般指标、免疫指标和生物化学指标的变化.结果 微创组患者手术出血量为(165.83±50.18)ml、手术时间为(91.87±22.64)分钟、引流量为(274.40±121.17)ml、引流时间为(2.37±1.45)天、术后排气时间为(1.32±0.84)天、住院时间为(8.34±1.25)天,均显著低于对照组(P均<0.05).手术后3天,微创组患者的CD4水平为(39.40±2.76)%、CD8水平为(24.34±2.45)%、CD4/CD8为(1.44±0.23),均优于对照组患者(P均<0.01).微创组患者术后3天TBil水平为(18.91±4.97)μmol/L、ALT为(48.63±5.75)U/L、PT为(15.55±1.16)秒;对照组患者的上述指标分别为(20.33±6.26)μmol/L、(50.25±5.07)U/L、(15.19±1.24)秒,差异无统计学意义(P均>0.05).微创组并发症发生率为9.23%,对照组为48.39%,差异有统计学意义(χ2=23.7649,P<0.001).结论 微创手术是治疗肝硬化合并胆囊结石患者的一种有效术式,创伤小,对肝功能影响小,并发症低于传统手术,安全性更高.