改良式经脐单孔腹腔镜胆囊切除术对中老年结石性胆囊炎合并冠心病患者应激反应和术后恢复的影响
Effect of Modified Transumbilical Single-incision Laparoscopic Cholecys-tectomy on Stress Response and Postoperative Recovery in Middle-aged and Elderly Patients with Calculous Cholecystitis Complicated with Coronary Heart Disease
陈健 1贺强 1张乐 1杨学干 1吴小云 1苏海燕 2朱红江3
作者信息
- 1. 075000 河北张家口,张家口市第一医院门诊部
- 2. 053000 河北衡水,衡水市第四人民医院检验科
- 3. 075000 河北张家口,张家口市第一医院外科
- 折叠
摘要
目的 分析改良式经脐单孔腹腔镜胆囊切除术对中老年结石性胆囊炎合并冠心病患者应激反应、术后恢复的影响.方法 回顾性选取2021 年7 月至2022 年12 月收治的150 例中老年结石性胆囊炎合并冠心病患者,根据手术方案不同分为传统三孔组78 例、改良单孔组72 例.传统三孔组行常规腹腔镜胆囊切除术,改良单孔组行改良式经脐单孔腹腔镜胆囊切除术.比较2 组围术期及术后恢复情况,术前及术后 12h炎症指标、应激指标、心肌酶水平,术后住院期间并发症发生情况.结果 与传统三孔组比较,改良单孔组手术时间更长,术中出血量更少,首次进食时间、肛门排气时间、住院时间更短(P＜0.05).术后 12 h,2 组血清白细胞介素-6、肿瘤坏死因子-α、C反应蛋白、去甲肾上腺素、皮质醇、肾上腺素、心肌型肌酸激酶同工酶、心肌肌钙蛋白I水平均较术前升高,但改良单孔组更低(P＜0.05).术后住院期间,传统三孔组总并发症发生率为11.54%(9/78),高于改良单孔组的 2.78%(2/72,P＜0.05).结论 改良式经脐单孔腹腔镜胆囊切除术可减轻中老年结石性胆囊炎合并冠心病患者应激反应,抑制炎症,缓解心肌损伤,促进术后恢复,安全性更高.
Abstract
Objective To analyze the effect of modified transumbilical single-incision laparoscopic cholecystectomy on stress response and postoperative recovery of middle-aged and elderly patients with calculous cholecystitis complicated with coronary heart disease(CHD).Methods In total,150 middle-aged and elderly patients with calculous cholecystitis compli-cated with CHD admitted from July 2021 to December 2022 were retrospectively selected for study,and were divided into tra-ditional three-incision group(n=78)and modified single-incision group(n=72)according to different surgical protocols.The traditional three-incision group received conventional laparoscopic cholecystectomy,and the modified single-incision group received modified transumbilical single-incision laparoscopic cholecystectomy.The perioperative and postoperative recovery,inflammation indexes,stress indicators,myocardial enzyme levels before and at 12 h after surgery,and complications during postoperative hospitalization were compared between the two groups.Results Compared with the traditional three-incision group,the modified single-incision group had longer duration of surgery,less intraoperative blood loss,shorter time to first food intake,the first time of anal exhaust and length of hospital stay(P<0.05).At 12 h after surgery,serum levels of inter-leukin-6,tumor necrosis factor-α,C-reactive protein,norepinephrine,cortisol,epinephrine,myocardial creatine kinase isoenzyme and cardiac troponin I in the two groups were higher than those before surgery,but lower in the modified single-incision group(P<0.05).During postoperative hospitalization,the total complication rate of the traditional three-incision group was 11.54％(9/78),which was higher than that of the modified single-incision group 2.78％(2/72,P<0.05).Conclusion Modified transumbilical single-incision laparoscopic cholecystectomy can reduce stress response,inhibit inflam-mation,relieve myocardial damage,promote postoperative recovery and improve safety in middle-aged and elderly patients with calculous cholecystitis complicated with CHD.
关键词
结石性胆囊炎/冠心病/中老年/改良式经脐单孔腹腔镜胆囊切除术/应激反应/术后恢复/心肌酶/炎症Key words
Calculous cholecystitis/Coronary heart disease/Middle-aged and elderly/Modified transumbilical sin-gle-incision laparoscopic cholecystectomy/Stress response/Recovery after surgery/Myocardial enzymes/Inflammation引用本文复制引用
出版年
2025
国家科技期刊平台
NSTL
万方数据