【作者】 张风华；

【导师】 邓勇； 秦伟； 樊海宁； 王海久；

【作者基本信息】 青海大学 ， 外科学， 2011， 硕士

【摘要】 目的比较腹腔镜与开腹胆囊切除术减轻老年病人术后应激反应和术后疲劳综合征的影响,为腹腔镜胆囊切除术治疗老年人胆囊结石是否具有微创优越性提供相关的客观依据。方法筛选符合相关适应症的胆囊结石患者40例,年龄为60岁≤年龄≤70岁;随机分为两组,每组各20例（两组病人性别,年龄等无显著性差异）即腹腔镜胆囊切除术（laparoscopic cholecystectomy, LC）手术组和开腹胆囊切除术（tra- ditional open cholecystectomy, OC）手术组。于手术前1天（T₀）、术后第1天（T₁）、2天（T₂）、3天（T₃）作为观察点,分别检测手术前后白介素6（Inter- leukin-6,IL-6）,白介素10（Interleukin-10,IL-10）,C-反应蛋白（C-reactive protein,CRP）,白细胞（white blood cell,WBC）计数及中性粒细胞（Neutropils）分类,皮质醇等指标;于术后第1天（T₁）、2天（T₂ ）、3天（T₃）作为观察点,分别检测病人的术后疲劳评分指数,统计并比较两组的平均手术时间,术中出血量,术后镇痛用药率,术后发热天数,平均住院天数等方面做分析。结果1.术前两组病人的IL-6浓度无显著性差异;术后两组病人的IL-6均明显升高,与T₀期相比有显著性差异,并且在T₁期达到高峰,在T₂, T₃期逐渐下降;术后T₁,T₂期LC手术组病人的IL-6浓度和OC手术组病人的相比较,LC手术组的均较OC手术组的低。2.术前两组病人的IL-10浓度相比无显著性差异;术后两组病人各期的IL-10浓度从T₁期开始降低;LC手术组病人的IL-10浓度在T₂期最低,在T₁、T₃期也低于术前;OC手术组病人的IL-10浓度在T₃期达到最低,在T₁、T₂期不同程度的降低;组间相比较,在T₂、T₃期LC手术组的值明显高于OC手术组的值。3.术前两组病人的CRP浓度无显著性差异;术后各期相比较,两组病人术后CRP水平均升高,在T₁期达到最高值,OC手术组除了术后各期CRP浓度明显高于LC手术组外,T₃期CRP仍然明显高于术前,但是LC手术组T₃期已经接近于正常;组间相比较,术后各期LC手术组较OC手术组CRP浓度低。4.术前两组病人WBC计数和中性粒细胞分类无显著性差异;术后OC组病人WBC计数T₁、T₂、T₃期均较术前升高,在术后T₁期达到高峰;LC组病人T₁、T₂期较术前升高,T₃期接近术前水平;组间相比较,OC手术组病人的WBC计数在术后各期较LC手术组病人的升高明显。5.术前两组病人的皮质醇浓度无显著性差异;术后LC手术组病人的皮质醇浓度T₁、T₂、T₃期均无明显升高,与T₀期相比无显著性差异;术后OC手术组病人的皮质醇浓度在T₁期升高,和T₀期相比有显著性差异,在T₂期开始回落到正常,组间相比较,在T₁期LC手术组的皮质醇浓度低于OC手术组的皮质醇浓度。6.两组病人术后各期的术后疲劳评分均升高,在术后T₁期评分值达到高峰,组间相比较,在术后各期的评分值OC手术组均高于LC手术组。结论与开腹胆囊切除术相比,腹腔镜胆囊切除术治疗老年患者胆囊结石,可以明显的减少术后应激,减轻老年病人术后疲劳综合的征状,临床疗效可靠,有着较高的临床应用价值。更多还原

【Abstract】 Objective:T_o study whether the elderly patients’post-operative stress response and fatigue syndrome can be eased by laparoscopic cholecystectomy,trying to offer objective proof for the superiority of laparoscopic cholecystectomy in curing the elderly patients with gallbladder stone.Methods:In the beginning, forty elderly male and female gallbladder stone patients, aging from 60 to 70, have been under screening in terms of relevant indication. T_hen the selected patients were divided into 2 groups, and 20 patients with no significant differences of gender and no age in each group. T_he two groups were named as laparoscopic cholecystectomy operation group （L.C） and open–cholecystectomy operation group （O.C）. Next, the day before the operation was marked T₀, the first day after operation T₁, the second day after operation T₂, the third day after operation T₃ . T₀, T₁, T₂, T₃ were chosen as the observation points. Later, various indicators, both in pre-operation and post-operation, were examined, such as Interleukin-6 （IL-6）, Interleukin-10（IL-10）, C-reactive protein （CRP）, white blood cell （WBC）, Neutropils and Cortisol etc. At last, from the observation points T₁, T₂, T₃ , some analysis were made, such as assessing the patients’post-operation fatigue, counting and comparing the two groups’average operation time, operation blood loss amount, post-operation analgesic using rate, the post-operation fever days, and the average length of hospitalization.Results:1. In pre-operation, there was no significant IL-6 density level distinction between the two groups. In post-operation, a significant IL-6 density level increase was detected in the two groups. And some significant IL-6 levels distinctions were revealed when compared with that of T₀. Besides, IL-6 level reaches its peak in the T₁ , then gradually declines in the T₂ and T₃ . In the T₁ and T₂ , in terms of IL-6 density levels, L.C’s were lower than O.C’s .2. In pre-operation, there was no significant IL-10 density distinction between the two group’s patients. In post-operation, from T₁, the IL-10 density of patients in two groups begins to decline; IL-10 densities of the patients in L.C were at the lowest level in the T₂ and show a striking difference from O.C group. In addition, IL-10 densities in the T₁ and T₃ were lower than that of pre-operation; By contrast, for the O.C IL-10 density levels of the patients were at the lowest level in the T₃ after some declining in the T₁ and T₂. Comparing the two groups, in the T₂ and T₃ L.C’s IL-10 density levels were significantly higher than O.C’s.3. In pre-operation, there was no significant CRP density distinction between the two group’s patients; in the different post-operation periods, CRP levels in both the two groups’patients rise and reach its peak in the T₁.Meanwhile, CRP density levels in O.C were significantly higher than those of LC. Besides, in the T₃CRP levels of O.C were significantly higher than that of pre-operation. By contrast, in the T₃, CRP level of patients in the L.C has already restored to the normal level. Comparing the two groups, in post-operation L.C’s CRP density levels were significantly lower than O.C’s.4. In pre-operation, there was no significant distinction about WBC number, neutrophil category between the two group’s patients. In post-operation, WBC number of patients in the O.C group increases in the T₁, T₂, T₃ and reaches its peak in the T₁, By contrast, in the T₁ and T₂ the increasing WBC number of patients in L.C is detected, and it approaches to the normal level in the T₃. Comparing the two groups, O.C’s WBC number of patients reveals a more significant increase than L.C’s in post-operation periods. 5. In pre-operation, there was no significant distinction about cortisol densities between the two group’s patients. In post-operation, in terms of cortisol densities of the patients, no obvious increase in the T₁, T₂, T₃ was revealed in L.C group, and no significant difference from that of T₀ was presented. In post-operation cortisol densities of the patients in O.C increase in the T₁ before they restore to the normal in the T₂ , showing the significant differences from that of T₀ . Comparing the two groups, in the T₂ cortisol densities of the L.C patients were lower than O.C group’s. 6. In terms of post-operation fatigue syndrome levels of the two groups’patient, an increase in both the two groups was detected, and they both reach the peak in the T₁ .Comparing the two groups, the O.C’s post-operation fatigue syndrome levels were higher than L.C’s.Conclusion:In curing the elderly patients with gallbladder stone, compared with open–cholecystectomy, post-operative stress response and fatigue syndrome in the elderly patients can be satisfactorily eased by laparoscopic cholecystectomy. So it’s safe to conclude that the clinical value of laparoscopic cholecystectomy is reliable and significant.更多还原