| 摘要: |
| 目的 探讨腹腔镜胆囊切除术（LC）后患者胃肠道症状改善情况，并分析其影响因素。方法 回顾性分析2020年1月至2021年12月于海军军医大学（第二军医大学）第一附属医院肝胆胰腺外科接受LC治疗的患者资料。患者年龄＞18岁，排除恶性肿瘤。统计患者一般资料，包括病程、基础疾病、既往腹部手术史、术前检查结果；手术相关资料，包括中转开腹、胆道损伤、是否放置腹腔引流管；术后并发症，包括胆漏、出血、腹腔感染、切口感染、副损伤等。随访6个月，采用胃肠道症状评定量表（GSRS）对患者进行问卷调查。结果 173例患者中男84例（48.55%）、女89例（51.45%），平均年龄为（54.12±13.38）岁，发病的中位时间为6.00（1.75，24.00）个月。术后GSRS的中位总评分为0（0，1）分，较术前中位总评分［3（0，5）分］明显降低（P＜0.01）。患者腹痛症状术前出现110例（63.85%），术后16例（9.25%，P＜0.01）；烧心和反酸术前12例（6.94%），术后6例（3.47%，P＜0.05）；恶心呕吐术前38例（21.97%），术后2例（1.16%，P＜0.01）；上腹部紧抽感术前35例（20.23%），术后1例（0.58%，P＜0.01）；腹胀术前41例（23.70%），术后11例（6.36%，P＜0.01）；腹泻术后发生26例（15.03%），较术前增加14例（P＜0.01）。结论 LC术后患者胃肠道症状明显改善，通过GSRS评分可以全面且直观地分析患者上述症状在手术前后的变化。对于术后腹痛未全部缓解、腹泻症状病例增加的原因需进一步扩大样本进行分析。 |
| 关键词: 腹腔镜胆囊切除术 胃肠道症状评定量表 腹泻 影响因素 |
| DOI：10.16781/j.CN31-2187/R.20220352 |
| 投稿时间：2022-04-28修订日期：2022-09-07 |
| 基金项目: |
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| Improvement of gastrointestinal symptoms and its influencing factors in patients after laparoscopic cholecystectomy |
| ZHU Zhong-fei,HU Hao,HE Tian-lin* |
(Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the improvement of gastrointestinal symptoms in patients after laparoscopic cholecystectomy (LC), and analyze the influencing factors. Methods The clinical data of LC patients in Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 2020 to Dec. 2021 were analyzed retrospectively. The patients were older than 18 years, and those with malignant tumors were excluded. The general information (including course of disease, underlying diseases, previous surgical history, and preoperative examination), surgical-related data (including conversion to laparotomy, biliary tract injury, and whether to place an abdominal drain), and postoperative complications (including bile leakage, hemorrhage, abdominal infection, incision infection, and side injury) of patients were collected. All the patients were followed up for 6 months and investigated with the gastrointestinal symptom rating scale (GSRS). Results Among the 173 patients, 84 (48.55%) were males and 89 (51.45%) were females, with an average age of (54.12±13.38) years. The median time of onset was 6.00 (1.75, 24.00) months. The median total score of GSRS after operation was 0 (0, 1), which was significantly lower than that before operation (3 ［0, 5］) (P＜0.01). One hundred and ten (63.85%) cases complained of abdominal pain before operation and it decreased to 16 (9.25%) cases after operation (P＜0.01). Twelve (6.94%) cases presented heartburn and acid regurgitation before operation and 6 (3.47%) cases after operation (P＜0.05). There were 38 (21.97%) cases of nausea and vomiting before operation and 2 (1.16%) cases after operation (P＜0.01). Upper abdominal discomfort occurred in 35 (20.23%) cases before operation and 1 (0.58%) case after operation (P＜0.01). Abdominal distension was found in 41 (23.70%) cases before operation and 11 (6.36%) cases after operation (P＜0.01). Postoperative diarrhea occurred in 26 (15.03%) cases, with an increase of 14 cases (P＜0.01). Conclusion The gastrointestinal symptoms of patients after LC are significantly improved. The GSRS score can be used to comprehensively and intuitively analyze the changes of the above symptoms before and after the operation. The reasons for the persistent abdominal pain and diarrhea of patients after surgery need to be further analyzed with a large sample. |
| Key words: laparoscopic cholecystectomy gastrointestinal symptom rating scale diarrhea influencing factors |
