Clinical effect of laparoscopic cholecystectomy and prognostic analysis in patients with acute cholecystitis

• Main Author: XI Guangli
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2018-02-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=8762

ObjectiveTo investigate the effect of laparoscopic cholecystectomy on intraoperative and postoperative recovery and changes in serum levels of lipopolysaccharide (LPS), amylase (AMY), and adrenocorticotropic hormone (ACTH) after surgery in patients with acute cholecystitis (AC). MethodsA total of 98 patients with AC who were admitted to Xianyang Central Hospital from December 2015 to May 2017 were enrolled, and according to the surgical procedure, these patients were divided into observation group and control group, with 49 patients in each group. The patients in the control group were given conventional open cholecystectomy, and those in the observation group were given laparoscopic cholecystectomy. The two groups were compared in terms of intraoperative and postoperative recovery (length of surgical incision, time of operation, intraoperative blood loss, time to postoperative ambulation, and length of hospital stay), serum levels of LPS, AMY, and ACTH and immune function ［T lymphocyte subsets (CD3+, CD4+, CD4+/CD8+)］ before surgery and at 72 hours after surgery, and the incidence rate of complications after surgery. The t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. ResultsCompared with the control group, the observation group had significantly shorter length of surgical incision, time of operation, time to postoperative ambulation, and length of hospital stay, as well as significantly lower intraoperative blood loss (t=26.782, 2.950, 11.559, 14.678, and 28.997, all P＜0.05). The incidence of complications decreased during the 1-month follow-up (8.16% vs 22.45%, χ2=9.137, P=0.002). There were no significant differences in the serum levels of LPS, AMY, and ACTH, the percentages of CD3+ and CD4+ T cells, and CD4+/CD8+ ratio between the two groups before surgery (all P＞0.05); at 72 hours after surgery, compared with the control group, the observation group had significantly lower serum levels of LPS, AMY, and ACTH (t=8.762, 5.370, and 3.607, all P＜0.001) and significantly higher percentages of CD3+ and CD4+ T cells and CD4+/CD8+ ratio (t=5.604, 6.611, and 12.025, all P＜0.001). ConclusionLaparoscopic cholecystectomy has a good clinical effect in the treatment of AC and can effectively improve the serum levels of LPS and AMY, with a relatively slight impact on immune function. It helps to reduce postoperative stress response and incidence rate of complications.