经脐单孔腹腔镜胆囊切除术对胆囊结石患者疗效及其炎症水平的影响

薛金晶 张德龙 于鑫

[摘要] 目的 經脐单孔腹腔镜胆囊切除术对胆囊结石患者疗效及其炎症水平的影响。 方法 2016年10月至2019年10月间于本院治疗的胆囊结石患者80例，按照随机数字表法分为对照组和观察组，每组各40例。对照组行LC治疗，观察组行TUSPLC治疗。观察两组患者手术情况、术后疼痛、胃肠道恢复、血清炎症因子水平、免疫功能及血管内皮功能指标情况。 结果 观察组手术时间长于对照组，差异有统计学意义（P<0.05），两组患者术中出血量及住院时间比较，差异无统计学意义（P>0.05）;观察组患者肛门排气时间、肠鸣音时间、进食时间、排便时间均明显短于对照组（P<0.05），观察组术后6 h VAS评分及术后止痛药使用率均低于对照组（P<0.05），术后24 h两组患者VAS评分比较，差异无统计学意义（P>0.05）;术后两组患者血清淀粉酶、ICAM-1、MPO及IL-1水平较术前升高（P<0.05），观察组升高幅度低于对照组（P<0.05）;两组患者术后血清ET、NO、CD3+及IgM水平均低于术前（P<0.05）;术前及术后两组患者血管内皮功能及免疫指标比较，差异无统计学意义（P>0.05）。 结论 TUSPLC对胆囊结石患者疗效理想，可有效降低患者术后炎症因子水平，且患者术后疼痛程度小、胃肠功能恢复快。

[关键词] 胆囊结石;经脐单孔腹腔镜胆囊切除术;免疫功能;血管内皮功能

[Abstract] Objective The effect of transumbilical single port laparoscopic cholecystectomy on the curative effect and inflammation level of patients with gallstone. Methods A total of 80 patients with gallstone treated in our hospital from October 2016 to October 2019 were divided into the control group for LC treatment and the observation group for TUSPLC treatment using random number table. The surgery condition，postoperative pain，gastrointestinal recovery，serum inflammatory factor content， immune function and changes in vascular endothelial function indicators were observed in both groups. Results The surgery time in the observation group was longer than that in the control group， with significant difference（P<0.05）. There was no significant difference in the group amount of intraoperative blood loss and hospitalization stay between the two groups（P>0.05）. The time of anal exhaust， time resuming bowel sounds， eating time， defecation time in the observation group were all shorter than those in the control group（P<0.05）， 6 h postoperative VAS score and the utilization rate of analgesic postoperatively in the observation group were all lower than those in the control group（P<0.05）. There was no significant difference in VAS score between the two groups at 24 h postoperatively（P>0.05）. The levels of serum amylase， ET， ICAM-1， MPO and IL-1 between the two groups after surgery were increased more obviously than those before the surgery， and the increase in the observation group were lower than those in the control group（P<0.05）. The levels of serum ET， NO， CD3+ and IgM between the two groups after surgery were lower than those before surgery（P<0.05）. There was no significant difference in vascular endothelial function and immune indexes between the two groups before and after surgery （P>0.05）. Conclusion TUSPLC has an ideal curative effect on patients with gallstone. It can effectively reduce the content of postoperative inflammatory factors， with less postoperative pain and fast gastrointestinal recovery.

[Key words] Gallstone; Transumbilical single port laparoscopic cholecystectomy; Immunologic function; Vascular endothelial function

胆结石是临床常见外科疾病，为胆道系统出现结石，其病因包括基因遗传、体质肥胖、餐后零食、不吃早餐及运动较少等，尤其是目前人们生活水平不断提高，饮食结构发生了较大变化，导致胆结石的发病率逐年升高[1-2]。肝内胆管、肝外胆管及胆囊等位置均可存在胆结石，同时有报道称，临床15%～18%胆囊结石者合并胆总管结石[3-4]。临床对于胆囊结石疗法较多，而胆囊结石治疗金标准为腹腔镜胆囊切除术（Laparoscopic cholecystectomy，LC），但单一LC手术对胆囊结石患者病情缓解不够彻底，经脐单孔腹腔镜胆囊切除术（Transumbilical single-port laparoscopic cholecystectomy，TUSPLC）为传统LC手术基础上采用最先进微创技术，患者在手术时治疗设备可经脐单孔进入到腹腔内，使用脐带的皱襞遮挡手术切口，具有美容效果好、患者创伤小等优势。……