摘要
目的探究腹腔镜手术治疗高原地区肝囊型棘球蚴病(hepatic cystic echinococcosis,HCE)的临床效果。方法选取2021年4月至2022年3月西藏自治区人民医院普通外科收治的124例HCE患者进行前瞻性研究,根据手术方案的不同分为观察组(68例,采用腹腔镜手术治疗)和对照组(56例,采用开腹手术治疗)。比较两组的手术相关指标、创伤应激指标(皮质醇、C反应蛋白)、术后疼痛程度、肝病生存质量量表1.0(Liver Disease Quality of Life Questionnaire 1.0,LDQOL1.0)评分及并发症发生情况。结果观察组术中出血量少于对照组,术后进食时间、下床活动时间、排气时间、拔管时间、术后住院时间短于对照组,差异均有显著性(P<0.05)。术前两组血清皮质醇、C反应蛋白水平比较差异无显著性(P>0.05);术后3d和7d两组血清皮质醇、C反应蛋白水平均明显高于术前,但观察组明显低于对照组,差异有显著性(P<0.05);术后7d两组皮质醇、CRP水平均明显低于术后3d,差异有显著性(P<0.05)。两组术后疼痛程度均随时间延长而逐渐降低,且术后1d、3d和7d时观察组的疼痛程度均明显低于对照组,差异有显著性(P<0.05)。术前两组LDQOL1.0评分比较差异无显著性(P>0.05);术后1个月和3个月两组LDQOL1.0评分均明显高于术前,且观察组明显高于对照组,差异有显著性(P<0.05);术后3个月两组LDQOL1.0评分均明显高于术后1个月,差异有显著性(P<0.05)。观察组并发症发生率(2.94%)与对照组(1.79%)比较差异无显著性(P>0.05)。结论腹腔镜手术治疗高原地区HCE创伤小、术后恢复快、疼痛程度轻,可有效提高患者生活质量,在严格把握适应证的前提下值得临床应用。
Objective To explore the clinical effect of laparoscopic surgery in the treatment of hepatic cystic hydatid disease(HCE)in plateau areas.Method 124 HCE patients in our hospital from April 2021 to March 2022 were selected for prospective study.According to different surgical plans,they were divided into two groups,of which 56 patients were treated with laparotomy and included in the control group,and 68 patients were treated with laparoscopic surgery and included in the study group.Comparison of treatment,serum traumatic stress indicators[cortisol(COR),C-reactive protein(CRP)],complication rates,postoperative pain levels[numerical rating scale(NRS)scores],and quality of life[liver disease quality of life scale(LDQOL1.0)scores]between the two groups.Result The amount of intraoperative bleeding in the observation group was less than that in the control group,and the postoperative feeding time,time to get out of bed,time to exhaustion,time to extubation,and postoperative hospitalization time were shorter than those in the control group,and the differences were significant(P<0.05).There was no significant difference between the serum cortisol and C-reactive protein levels of the two groups before surgery(P>0.05);the serum cortisol and C-reactive protein levels of the two groups were significantly higher than those before surgery at 3 d and 7 d after surgery,but the observation group was significantly lower than the control group,and the difference was significant(P<0.05);the cortisol and CRP levels of the two groups were significantly lower at 7 d after surgery than those at 3 d after surgery,but the indexes of the observation group were significantly lower than those of the control group,and the difference was significant(P<0.05).The difference was significant(P<0.05).The postoperative pain level in both groups was significantly reduced,and the pain level at 3 d postoperatively was significantly lower than that at 1 d postoperatively,and the pain level at 7 d postoperatively was significantly lower than that at 1 d and 3 d postoperatively;and the pain level in the observation group was significantly lower than that in the control group at 1 d,3 d and 7 d postoperatively,and the difference was significant(P<0.05).The difference between the LDQOL1.0 scores of the two groups before surgery was not significant(P>0.05);the LDQOL1.0 scores of the two groups at 1 month and 3 months after surgery were significantly higher than those before surgery,and the observation group was significantly higher than the control group,and the difference was significant(P<0.05);the quality of life of the two groups at 3 months after surgery was significantly higher than that at 1 month after surgery,and the quality of life of the observation group was significantly higher than that of the control group,and the difference was significant(P<0.05).The difference was significant(P<0.05).There was no significant difference(P>0.05)in the incidence of complications in the observation group(2.94%)compared with the control group(1.79%).Conclusion Laparoscopic surgery for HCE in plateau area has less trauma,faster postoperative recovery and less pain,and can more effectively improve the quality of life of patients.It is worthy of popularization and application under the premise of strictly grasping the indications.
作者
索郎多杰
高红桥
索朗达杰
巴桑顿珠
Suolang Duojie;Gao Hongqiao;Suolang Dajie;Basang Dunzhu(Department of General Surgery,Tibet Autonomous Region People’s Hospital,Xizang Tibet 850000,China;Department of General Surgery,Peking University First Hospital,Beijing 100034,China)
出处
《中国医刊》
CAS
2023年第7期726-730,共5页
Chinese Journal of Medicine
基金
西藏自治区自然科学基金组团式医学援藏项目(XZ2021ZR-ZY11(Z))。
关键词
肝囊型棘球蚴病
高原地区
腹腔镜手术
生活质量
Hepatic cystic echinococcosis
Plateau area
Laparoscopic surgery
Quality of life
作者简介
通信作者:高红桥,E-mail:doctor_ghq@163.com。
