Effect of retroperitoneal laparoscopic surgery on intestinal function recovery and serum T cell subsets in patients with gallbladder stones and chronic cholecystitis / 中国基层医药

ABSTRACT

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.