不同入路腹腔镜手术治疗对胆囊结石伴慢性胆囊炎患者免疫应激反应的影响

doi:10.3969/j.issn.1006-6233.2022.11.021

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Abstract Objective: To investigate the effect of different approaches of laparoscopic surgery on immune stress in patients with cholecystolithiasis complicated with chronic cholecystitis.Methods: From March 2020 to March 2022, 95 patients with cholecystolithiasis complicated with chronic cholecystitis who were treated by laparoscopic surgery in our hospital were selected as the research subjects. According to the random number table method, they were divided into anterior triangle approach group (n=47) and posterior triangle approach group (n=48). The perioperative related indicators (operation time, intraoperative blood loss, bowel function recovery time and hospitalization time), pain level at 12 h and 24 h after operation, and stress indexes before operation and 3 days after operation [leukocyte] were compared between the two groups. The levels of interleukin-6 (IL-6), C-reactive protein (CRP), cortisol], and immune function indexes (CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺), and postoperative complications were compared between the two groups. Results: The operation time, intraoperative blood loss, bowel function recovery time and hospital stay in the posterior triangle approach group were all shorter than those in the anterior triangle approach group (P<0.05). The analog scale (VAS) scores were significantly lower than those in the anterior triangle approach group (P<0.05); 3 days after operation, the levels of IL-6, CRP, cortisol and other stress indexes in the two groups were significantly higher than those before operation (P<0.05), and the indexes ascending range in the posterior triangle approach group were significantly lower than those in the anterior triangle approach group (P<0.05); 3 days after operation, CD3⁺, CD4⁺, CD4⁺/CD8⁺ in both groups were lower than those before operation (P<0.05), no significant change in CD8+ compared with preoperative (P>0.05), the reducing range of CD3⁺, CD4⁺, CD4⁺/CD8⁺ in the posterior triangle approach group were significantly higher than those in the anterior triangle approach group (P<0.05), and there were differences in CD8⁺ between the two groups Not significant (P>0.05); the total incidence of postoperative complications in the posterior triangle approach group was 6.00%, which was significantly lower than that in the anterior triangle approach group (22.22%) (P<0.05). Conclusion: Compared with the anterior triangular anatomical approach of the gallbladder, the laparoscopic cholecystectomy via the posterior gallbladder triangular anatomical approach can shorten the operation time, reduce intraoperative blood loss, intestinal function recovery time and hospitalization time, and can significantly improve the body's stress response, promote the recovery of the body's immune function, and reduce postoperative complications, which is worthy of clinical application.

Key words： Cholecystolithiasis complicated with chronic cholecystitis Laparoscopic surgery Anterior triangular anatomical approach Posterior triangular anatomical approach Immune function Stress response

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	FANG Lixia
	LI Ping
	WANG Shuiyuan
	et al

Cite this article:

FANG Lixia,LI Ping,WANG Shuiyuan, et al. Effect of Laparoscopic Surgery with Different Approaches on the Immune Stress Response in Patients with Cholecystolithiasis Complicated with Chronic Cholecystitis[J]. HeBei Med, 2022, 28(11): 1865-1868.

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2022.11.021 OR http://www.hbyxzzs.cn/EN/Y2022/V28/I11/1865

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