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Objective:To study the effect of local infiltration of ropivacaine in gallbladder triangle on agitation and postoperative pain in patients undergoing laparoscopic cholecystectomy (LC).Methods:108 patients with LC who met the requirements of this study treated in Yunnan Cancer Hospital from March 2018 to March 2021 were randomly divided into two groups, 54 cases in each group. Both groups received routine LC under general anesthesia. The observation group received ropivacaine for local infiltration in the gallbladder triangle, and the control group received the same amount of normal saline for local infiltration in the gallbladder triangle. The anesthesia indexes, agitation during awakening and postoperative pain were compared between the two groups.Results:There was no significant difference in extubation, anesthesia and recovery time between the observation group and the control group (all P>0.05); The scores of static and dynamic visual analogue scale (VAS) in the two groups reached the highest value at 6 h after operation, and then decreased gradually, with significant differences between the two groups ( F=15.28, 4.26, 11.06, 3.21, all P<0.05). The dynamic and static VAS scores of the observation group were lower than those of the control group at the time of awakening, 6 h, 12 h and 24 h after operation, with statistically significant difference (all P<0.05). Compared with the control group, the Riker sedation agitation score (SAS) and the incidence of agitation in the observation group were significantly lower (all P<0.05), and the effective times of analgesic pump pressing 24 hours after operation were significantly less ( P<0.05); There was no significant difference in SpO 2 level between the observation group and the control group ( P>0.05); The levels of heart rate (HR) and mean arterial pressure (MAP) in the two groups were significantly higher than those before anesthesia, and the rising degree in the observation group was significantly lower than that in the control group (all P<0.05); The levels of norepinephrine (NE), C-reactive protein (CRP) and cortisol in the two groups were significantly higher than those before anesthesia, and the rising degree in the observation group was significantly lower than that in the control group (all P<0.05). Conclusions:Local infiltration of gallbladder triangle with ropivacaine during LC can reduce the degree of postoperative pain, the use of PCIA pump and the occurrence of agitation during awakening, so as to maintain hemodynamic stability.
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Objective@#To analyze the effects of laparoscopic surgery after gallbladder laparoscopic surgery on intestinal function recovery and serum T cell subsets in patients with gallbladder stones and chronic cholecystitis.@*Methods@#From September 2016 to July 2018, 120 patients with gallbladder stones and chronic cholecystitis admitted to the Department of Hepatobiliary Surgery of Yuncheng Central Hospital were randomly divided into the control group (n=60) and the observation group (n=60) according to the digital table.The observation group underwent laparoscopic surgery through the posterior biliary anatomy of the gallbladder, and the control group underwent laparoscopic surgery through the gallbladder triangle.The perioperative condition of the patients with abdominal adhesion and non-adhesion was compared.The functional recovery time, operative time, intraoperative blood loss, length of hospital stay, serum inflammatory factors[tumr necrosis factor(TNF-α), interlek-6(IL-6), interlek-8(IL-8), C-reactive protein (CRP)], T cell subsets (CD3+, CD4+, CD8+), stress factors[adrenocorticotropic hormone (ACTH), cortisol]levels, and complication rates were observed.@*Results@#The intestinal function recovery time, intraoperative time, intraoperative blood loss, and hospitalization time in the observation group were (24.99±5.26)h, (24.99±5.26)min, (33.06±7.09)mL, (6.63±1.08)d, respectively, which were lower than those in the control group [(31.85±5.57)h, (54.33±4.89)min, (48.81±6.57)mL, (8.71±0.92)d], the differences were statistically significant (t=5.447, 19.016, 9.911, 8.918, all P<0.05). The TNF-α, IL-6, IL-8, CRP levels in the observation group at 12h after operation were (18.46±4.91)ng/L, (13.15±6.88)ng/L, (14.55±3.61)ng/L and (8.45±1.27)mg/L, respectively, which were lower than those in the control group [(22.47±5.82)ng/L, (15.66±6.24)ng/L, (17.71±2.92)ng/L, (10.14±0.97)mg/L], the differences were statistically significant (t=4.079, 2.093, 5.272, 8.192, all P<0.05). The CD3+, CD4+ and CD8+ percentages in the observation group at 12h after operation were (66.81±5.41)%, (38.99±3.45)% and (23.91±2.78), respectively, which were higher than those in the control group [(63.05±5.27)%, (35.19±3.42)%, (21.68±2.80)%], the differences were statistically significant (t=3.856, 6.059, 4.378, all P<0.05). The ACTH and cortisol levels in observation group at 12h after operation were (116.62±6.39)pg/mL and (188.87±10.26)ng/mL, respectively, which were lower than those in the control group [(127.74±9.11)pg/mL, (197.37±9.81)ng/mL], the differences were statistically significant (t=7.741, 4.638, all P<0.05). The incidence rate of complications in the observation group was 1.67%, which was lower than that in the control group (13.33%), and the difference was statistically significant (χ2=4.324, P=0.038).@*Conclusion@#Cholecystolithiasis with chronic cholecystitis can be accelerated by laparoscopic surgery after gallbladder anatomy.It can speed up the recovery of intestinal function, shorten the operation time and hospitalization time, reduce the amount of intraoperative blood loss, improve the body's inflammatory state and protect the body's immune function.To reduce the body's stress response, reduce the incidence of complications such as bile duct injury, and first dissect the posterior triangle of the gallbladder during operation, which helps to reduce the occurrence of gallbladder artery bleeding and bile duct injury.
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Objective To analyze the effects of laparoscopic surgery after gallbladder laparoscopic surgery on intestinal function recovery and serum T cell subsets in patients with gallbladder stones and chronic cholecystitis.Methods From September 2016 to July 2018,120 patients with gallbladder stones and chronic cholecystitis admitted to the Department of Hepatobiliary Surgery of Yuncheng Central Hospital were randomly divided into the control group (n =60) and the observation group (n =60) according to the digital table.The observation group underwent laparoscopic surgery through the posterior biliary anatomy of the gallbladder,and the control group underwent laparoscopic surgery through the gallbladder triangle.The perioperative condition of the patients with abdominal adhesion and non -adhesion was compared.The functional recovery time,operative time,intraoperative blood loss,length of hospital stay,serum inflammatory factors[tumr necrosis factor(TNF-α),interlek-6 (IL-6),interlek-8 (IL-8),C-reactive protein (CRP)],T cell subsets (CD3+,CD4+,CD8+),stress factors [adrenocorticotropic hormone (ACTH),cortisol]levels,and complication rates were observed.Results The intestinal function recovery time,intraoperative time,intraoperative blood loss,and hospitalization time in the observation group were (24.99 ±5.26)h,(24.99 ±5.26)min,(33.06 ± 7.09)mL,(6.63 ± 1.08)d,respectively,which were lower than those in the control group [(31.85 ± 5.57)h,(54.33 ± 4.89) min,(48.81 ± 6.57) mL,(8.71 ± 0.92) d],the differences were statistically significant (t =5.447,19.016,9.911,8.918,all P ＜0.05).The TNF-α,IL-6,IL-8,CRP levels in the observation group at 12h after operation were (18.46 ±4.91) ng/L,(13.15 ± 6.88) ng/L,(14.55 ± 3.61) ng/L and (8.45 ± 1.27) mg/L,respectively,which were lower than those in the control group [(22.47 ± 5.82)ng/L,(15.66 ± 6.24) ng/L,(17.71 ± 2.92) ng/L,(10.14 ± 0.97) mg/L],the differences were statistically significant (t =4.079,2.093,5.272,8.192,all P ＜ 0.05).The CD3+,CD4+ and CD8+ percentages in the observation group at 12h after operation were (66.81 ±5.41)％,(38.99 ± 3.45) ％ and (23.91 ± 2.78),respectively,which were higher than those in the control group [(63.05 ± 5.27) ％,(35.19 ± 3.42)％,(21.68 ± 2.80)％],the differences were statistically significant (t =3.856,6.059,4.378,all P ＜0.05).The ACTH and cortisol levels in observation group at 12h after operation were (116.62 ± 6.39)pg/mL and (188.87 ± 10.26) ng/mL,respectively,which were lower than those in the control group [(127.74 ± 9.11) pg/mL,(197.37 ± 9.81) ng/mL],the differences were statistically significant (t =7.741,4.638,all P ＜ 0.05).The incidence rate of complications in the observation group was 1.67％,which was lower than that in the control group (13.33％),and the difference was statistically significant (x2 =4.324,P =0.038).Conclusion Cholecystolithiasis with chronic cholecystitis can be accelerated by laparoscopic surgery after gallbladder anatomy.It can speed up the recovery of intestinal function,shorten the operation time and hospitalization time,reduce the amount of intraoperative blood loss,improve the body's inflammatory state and protect the body's immune function.To reduce the body's stress response,reduce the incidence of complications such as bile duct injury,and first dissect the posterior triangle of the gallbladder during operation,which helps to reduce the occurrence of gallbladder artery bleeding and bile duct injury.