| Abstract:Objective:By observing the clinical indexes of patients with gallbladder diseases, such as postoperative pain, postoperative temperature,the cost of hospitalization, and so on.we will investigate which will be highly advantageous between gasless laparoscopic cholecystectomy(GLC)and laparoscopic cholecystectomy(LC).By detectting serum IL-2 and IL-6 concentration, the blood rheologic indexes of patients with gallbladder diseases, we will investigate which will be highly advantageous between gasless laparoscopic cholecystectomy(GLC)and laparoscopic cholecystectomy(LC)in the immune function and the blood rheologic indexes aspects. We will investigate the clinical value of gasless laparoscopic cholecystectomy gasless laparoscopic cholecystectomy(GLC)and laparoscopic cholecystectomy (LC) from comparison of basic and clinical research. Methods:60 patients with gallbladder disease who were randomly divided into gasless laparoscopic cholecystectomy(GLC)and laparoscopic cholecystectomy(LC)group, and each group was 30 patients;and 10 patients gotten gallbladder disease with coronary artery disease and COPD who were selected as gasless laparoscopic cholecystectomy 2(GLC2).By using surgical procedures of gasless laparoscopic cholecystectomy 1(GLC1)group and laparoscopic cholecystectomy(LC) group,we will observe the clinical indexes of patients with gallbladder diseases,such as postoperative pain, postoperative temperature, the cost of hospitalization, and so on.By measuring the arterial bloos gas analysis of patients with gallbladder diseases 6 hours before surgery and following surgery, we will detect the level of the blood rheologic indexes. Results:1. clinical observed indexes 1.1 postoperative pain Gasless laparoscopic cholecystectomy 1(GLC1)group have 7%patients with gallbladder diseases to use painkillers and laparoscopic cholecystectomy(LC)group have 13%patients with gallbladder diseases to use painkillers.there is statistical differences(P<0.01).1.2 Postoperative temperature gasless laparoscopic cholecystectomy 1(GLC1) group have zero case above a temperature of 38 degree and laparoscopic cholecystectomy (LC)group patients have three cases(10%) above a temperature of 38 degree.there is statistical differences (P<0.01).1.3 complication after operation Laparoscopic cholecystect-omy (LC)group patients have one case lead to subcutaneous emphysema and have one case lead to bile leakage.The other groups have no severe complications.there is statistical differences(P<0.01).1.4 comparison of the cost of hospitalization The total hospitalization expenses of GLC(1), GLC(2)and LC group patients is (4420.13±123.67) yuan, (4451.17±156.67) yuan and (4521.03±101.20) yuan, the total hospitaliza- tion expenses of LC group patients is higher than those of the GLC group patients, there is statistical differences(P<0.01).1.5 bleeding during operation the bleeding during operation of GLC(1), GLC(2) and LC group patients is 19.2±11.32ml,21.2±10.32ml and 20.18±10.23ml, There was no difference (P>0.05).1.6 operation time The operation time of GLC(1), GLC(2) and LC group patients is 46.2±20.2min,47.2±21.1min and 48.6±20.1min, There was no difference(P>0.05).1.7 days of using antibiotics after operation The days of using antibiotics after operation of GLC(1), GLC(2) and LC group patients is 2.2±1.08 days,2.5±1.05 days and 2.3±1.07days, There was no difference (P>0.05).1.8 recovery time of intestinal function after operation The days of recovery time of intestinal function after operation of GLC(1), GLC(2)and LC group patients is 1.98±0.56 days,1.97±0.58 days and 2.01±0.32 days, There was no difference (P>0.05).1.9 cases of recovery normal action in 2 days after operation The cases of recovery normal action in 2 days after operation of GLC(1), GLC(2) and LC group patients is 27 cases,9cases and 26 cases, There was no difference (P>0.05).2 aspects of fundamental experimental studies.2.1 The levels of cytokine in the serum there was no difference in the levels of IL-2 and IL-6 in the before and after operations about GLC(1) group patients(P>0.05). There was no difference in the levels of IL-2 and IL-6 in the preoperative patients about the GLC group and LC group (P>0.05). The levels of IL-2 in the serum in the postoperative patients about GLC(2)and LC group were lower than those of the preoperative patients about GLC(2)and LC group(P>0.05); IL-6 in the serum in the postoperative patients about GLC(2) and LC group were higher than those of the preoperative patients about GLC(2) and LC group(P<0.05); The levels of IL-2 in the serum in the postoperative patients about GLC(2) and LC group were lower than those of the postoperative patients about about GLC(1) group(P<0.05); The levels of IL-6 in the serum in the postoperative patients about LC(2) and LC group were higher than those of the postoperative patients about GLC(1) group(P<0.05); 2. the indexes of blood gas analysis, the blood routine, PT and CT The levels of PaCO2(mmHg)in the postoperative patients about LC group were higher than those of the preoperative patients about LC group (P<0.05); There was no difference in the levels of PH, WBC, PT and CT in the groups and among threegroups(P>0.05). Conclusions:1. Gasless laparoscopic cholecystectomy (GLC)has the advantage of slight trauma, mile pain, decreased economic burden and complications, comparison with LC group. There were no remarkable difference in the bleeding during operation, the days of using antibiotic after operation aspect, and so on.2. GLC group patients have the advantage of the immune function, comparison with LC group. 3. Pneumoperitoneum have a remarkable influence on the blood rheologic. 4. For some contraindicated patients who have no routine operation chance, gasless laparoscopic cholecystectomy(GLC)is a important valuable complement. |
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