本文選題：膽囊切除術(shù)后 + 腹瀉��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)回顧性研究的調(diào)查方法,探討腹腔鏡膽囊切除術(shù)后患者第1、3、6、9個(gè)月腹瀉發(fā)生的發(fā)病率,術(shù)后腹瀉出現(xiàn)及消失的時(shí)間以及患者性別、年齡、體重身高指數(shù)、術(shù)前膽囊收縮功能情況、精神心理狀況、飲食等因素與腹腔鏡膽囊切除術(shù)后腹瀉發(fā)生的相關(guān)性,以分析腹腔鏡膽囊切除術(shù)后患者發(fā)生腹瀉的相關(guān)因素,以期對(duì)術(shù)后腹瀉的評(píng)估、預(yù)防以及對(duì)需行腹腔鏡膽囊切除術(shù)患者的治療提供臨床指導(dǎo)。方法:通過(guò)檢索2014年12月-2015年12月間于大連醫(yī)科大學(xué)附屬第一醫(yī)院腹腔鏡外科行腹腔鏡膽囊切除術(shù)后患者的相關(guān)基本病例資料,并通過(guò)電話聯(lián)系、微信或者電子郵件方式分別對(duì)患者術(shù)后1個(gè)月、3個(gè)月、6個(gè)月、9個(gè)月進(jìn)行相關(guān)內(nèi)容隨訪。隨訪過(guò)程中排除因術(shù)中誤傷出現(xiàn)膽管損傷、膽瘺及腸瘺患者,隨訪期間患者術(shù)后繼發(fā)膽總管結(jié)石而行手術(shù)治療患者,因胃腸道疾病而行胃腸道手術(shù)者、行開(kāi)腹手術(shù)治療疾病患者以及隨訪期間發(fā)生感染性腹瀉者或者術(shù)前患有引起腹瀉相關(guān)疾病患者。目前尚沒(méi)有明確診斷PCD的臨床標(biāo)準(zhǔn),其臨床特征尚未有統(tǒng)一描述,通過(guò)復(fù)習(xí)八版《診斷學(xué)》腹瀉診斷、羅馬Ⅲ診斷標(biāo)準(zhǔn)以及查閱相關(guān)文獻(xiàn)確定PCD基本臨床特征:①有腹腔鏡下膽囊切除病史、術(shù)前無(wú)腹瀉癥狀。②術(shù)后排便規(guī)律改變、排便次數(shù)≥3次/天。③發(fā)生腹瀉時(shí)存在緊迫感、無(wú)體溫升高、惡心、嘔吐,無(wú)腹痛及黏液膿血便。④排便性狀為不成形便、水樣便或可見(jiàn)脂滴。通過(guò)查閱患者入院時(shí)基本資料,設(shè)計(jì)相關(guān)表格記錄患者性別、年齡并計(jì)算出患者體重身高指數(shù);通過(guò)查閱患者術(shù)前膽囊功能彩色多普勒超聲檢查,記錄患者術(shù)前膽囊收縮功能情況;患者精神心理狀態(tài)評(píng)估采用焦慮自評(píng)量表進(jìn)行綜合評(píng)分。結(jié)果:檢索2014年12月-2015年12月間行腹腔鏡膽囊切除術(shù)患者病例資料,其中122例符合隨訪標(biāo)準(zhǔn)。術(shù)后1、3、6、9月腹瀉發(fā)生率分別為54%、33%、28%、19%(χ2=36.80,P0.01),差異具有統(tǒng)計(jì)學(xué)意義。有54%的患者術(shù)后第1個(gè)月即出現(xiàn)腹瀉,73%患者于術(shù)后第9個(gè)月隨訪中腹瀉癥狀可完全消失,但仍有19%患者腹瀉癥狀持續(xù)存。術(shù)后腹瀉的發(fā)生與性別無(wú)明顯統(tǒng)計(jì)學(xué)差異,性別與腹瀉的發(fā)生無(wú)確切相關(guān)性(χ2=0.07,P=0.85)。隨著患者年齡的增長(zhǎng),PCD發(fā)生率逐步下降,通過(guò)χ2檢驗(yàn)(χ2=12.44,P=0.02),患者年齡與PCD的發(fā)生具有統(tǒng)計(jì)學(xué)意義。符合納入標(biāo)準(zhǔn)患者按膽囊收縮功能分組PCD發(fā)病率為:膽囊收縮功能20%,PCD發(fā)病率為11%;20%≤膽囊收縮功能≤30 PCD發(fā)病率為22%;膽囊收縮功能30%,PCD發(fā)病率為36%,膽囊收縮功能與PCD發(fā)生呈正相關(guān)性,患者膽囊收縮功能與PCD的發(fā)生具有統(tǒng)計(jì)學(xué)意義(χ2=23.72,,P0.01)。符合納入標(biāo)準(zhǔn)患者按體重身高指數(shù)分組,正常患者PCD發(fā)生率為13%;超重患者PCD發(fā)生率為30%;肥胖患者PCD發(fā)生率為26%,患者BMI與PCD的發(fā)生具有統(tǒng)計(jì)學(xué)意義(χ2=23.72,P0.01)。符合納入標(biāo)準(zhǔn)患者分別按照精神焦慮程度分組,其中無(wú)精神焦慮組PCD發(fā)病率為15%;輕度焦慮患者PCD發(fā)病率24%;中度焦慮患者PCD發(fā)病率為25%;重度焦慮患者PCD發(fā)病率為6%,隨著患者精神焦慮程度加重,PCD發(fā)生率逐步升高(χ2=13.58,P=0.01)。符合納入標(biāo)準(zhǔn)患者分別按飲食情況分為正常飲食組,低脂飲食組,其中正常飲食組PCD發(fā)病率為48%,低脂飲食組PCD發(fā)病率為22%(χ2=13.51,P0.01),患者飲食情況與PCD的發(fā)生具有統(tǒng)計(jì)學(xué)意義。結(jié)論:腹腔鏡膽囊切除術(shù)后患者腹瀉的發(fā)病率隨時(shí)間的推移逐步下降,部分患者腹瀉癥狀可完全消失;腹腔鏡膽囊切除術(shù)后腹瀉的發(fā)生與性別差異無(wú)明確相關(guān)性;但與年齡、體重身高指數(shù)、術(shù)前膽囊功能情況、精神心理狀況、飲食等因素密切相關(guān)。
[Abstract]:Objective: To investigate the incidence of diarrhea in 1,3,6,9 months after laparoscopic cholecystectomy, the occurrence and disappearance of postoperative diarrhea, the sex, age, weight and height index of the patients, the preoperative gallbladder contraction function, the psychosocial status, diet and other factors and laparoscopic cholecystectomy. The correlation of postdiarrhea occurred to analyze the related factors of diarrhea in patients after laparoscopic cholecystectomy, with a view to assessing postoperative diarrhea, preventing and providing clinical guidance for the treatment of patients requiring laparoscopic cholecystectomy. Methods: through the retrieval of the abdomen of the First Affiliated Hospital of Dalian Medical University, December 2014, in December -2015 years. The basic case data of the patients after laparoscopic cholecystectomy were followed up by telephone connection, WeChat or e-mail were followed up for 1 months, 3 months, 6 months, and 9 months respectively. During the follow-up, the bile duct injury, biliary fistula and intestinal fistula were excluded, and the patients were followed up during the follow-up period. Patients with secondary choledocholithiasis after operation were operated on, patients who underwent gastrointestinal surgery for gastrointestinal diseases, open surgery to treat patients with disease, patients with infectious diarrhea during follow-up or patients with diarrhea related diseases before operation. There is no definite clinical standard for diagnosing PCD and its clinical features have not yet been unified. Description, by reviewing the diagnosis of the eighth edition of the diagnosis, the diagnosis of diarrhea, the Rome III diagnostic standard and consulting the relevant literature to determine the basic clinical features of PCD: (1) there is a history of laparoscopic cholecystectomy, no symptoms of diarrhea before operation. (2) the change of bowel movement and the number of defecation more than 3 times / day. (3) there is a sense of urgency, no temperature rise, nausea, vomiting, when abdominal diarrhea occurs. There was no abdominal pain and mucous purulent stool. 4. Defecation characters were unformable stool, water urine or visible lipid droplets. By consulting the basic data of the patient's admission, related forms were designed to record the patient's sex, age, and the body weight and height index of the patient; the preoperative gallbladder contractions were recorded by examination of the preoperative gallbladder function color Doppler ultrasonography. The patient's mental state assessment was evaluated by the self rating anxiety scale. Results: the data of patients with laparoscopic cholecystectomy in December 2014 -2015 year and December were retrieved. 122 cases were consistent with follow up criteria. The incidence of diarrhea in 1,3,6,9 months after operation was 54%, 33%, 28%, 19% (x 2=36.80, P0.01), and the difference was statistically significant. 54% of the patients had diarrhoea at first months after operation, and 73% patients had complete disappearance of diarrhea in ninth months after the operation, but there were still 19% patients with persistent diarrhea. There was no statistically significant difference in the occurrence of diarrhoea after operation. There was no definite correlation between the sex and the occurrence of diarrhea (x 2=0.07, P=0.85). The incidence of PCD decreased gradually. The incidence of PCD was statistically significant by the x 2 test (x 2=12.44, P=0.02). The incidence of PCD in the group according to the standard of cholecystoconstriction was 20%, the incidence of PCD was 11%, and the incidence of cholecystokinin less than 30 PCD was 22%, and gallbladder contractile function 30%, PCD hair was found. The disease rate was 36%, the gallbladder contractile function was positively correlated with the occurrence of PCD. The gallbladder contractile function and the occurrence of PCD were statistically significant (x 2=23.72, P0.01). The patients were grouped according to the body weight and height index (P0.01). The incidence of PCD in normal patients was 13%, the incidence of PCD in overweight patients was 30%, the incidence of PCD in obese patients was 26%, BMI and PCD in patients were BMI and PCD. The incidence was statistically significant (x 2=23.72, P0.01). The patients in accordance with the inclusion criteria were grouped according to the mental anxiety level respectively, among them, the incidence of PCD in the non mental anxiety group was 15%, the incidence of PCD in mild anxiety patients was 24%, the incidence of PCD in moderate anxiety patients was 25%, the incidence of PCD in severe anxiety patients was 6%, and the degree of mental anxiety was aggravated, PCD The incidence was gradually increased (x 2=13.58, P=0.01). The patients were divided into normal diet group and low fat diet group according to the diet. The incidence of PCD in normal diet group was 48%, the incidence of PCD in low fat diet group was 22% (x 2=13.51, P0.01). The diet and PCD were statistically significant. Conclusion: laparoscopic cholecystectomy The incidence of diarrhoea in the patients gradually decreased with time, and the symptoms of diarrhea in some patients disappeared completely. The occurrence of diarrhea after laparoscopic cholecystectomy had no definite correlation with sex difference, but it was closely related to age, body weight and height index, preoperative gallbladder function, mental condition, diet and other factors.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.4
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本文編號(hào)：1906754