腹腔镜与开腹阑尾切除术对机体炎症影响的比较  

Comparative study of different influence of laparoscopic appendectomy and open appendectomy on inflammation

作　　者：刘柏春[1] 曾跃红[1] 田海清[1] 李龙平[1] 

机构地区：[1]中南大学湘雅医学院益阳临床学院普外科, 湖南省益阳市413000

出　　处：《中国医药》2010年第2期150-152,共3页China Medicine

摘　　要：目的比较腹腔镜与开腹阑尾切除术对机体炎症的影响。方法160例急性阑尾炎患者采用抽签方式分为腹腔镜阑尾切除术组（LA组）和开腹阑尾切除术组（OA组），各80例，分别采用LA及OA术式手术。分别于术前和术后1、3d检测2组患者的外周血C反应蛋白（CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）和白细胞计数（WBC），并进行对比分析，同时比较2组患者的手术时间、术后肠道功能恢复时间、住院时间、住院费用及术后并发症发生情况。结果LA组的肠功能恢复时间[（12．8±5．8）d]和住院时间[（4．6±1．4）d]明显低于OA组[（27．6±9．6）d与（6．7±1．1）d]，差异有统计学意义（t=11．802，10．550，均P〈0．01）。LA组术后1d和3d的CRP[（58．4±24．6）mg／L、（25．1±12．7）mg／L]、IL-6[（31．12±10．45）ng／L、（22．32±7．58）ng／L]、TNF-α[（1．11±0．31）mg／L、（0．98±0．39）mg／L]和WBC[（10．13±1．84）×10^9／L、（8．29±2．66）×10^9／L]水平明显低于OA组[CRP：（91．7±42．3）mg／L、（41．7±24．6）mg／L，IL-6：（58．21±11．26）ng／L、（39．77±8．24）ng／L，TNF-仅：（1．72±0．44）mg／L、（1．29±0．47）mg／L。WBC：（15．6±2．48）×10^9／L、（12．3±2．72）×10^9／L]，差异有统计学意义（术后1d：t=6．087，15．773，10．137，15．843，术后3d：t=5．363，13．940，4．540，9．427，均P〈0．01）。2组患者术后均无并发症发生。结论LA治疗急性阑尾炎比OA对机体损伤更小，可有效地保护机体免疫功能，有利于术后快速康复。Objective To investigate the different influence of laparoscopic appendectomy and open appendectomy on inflammation. Methods A total of 160 cases of acute appendicitis were randomly divided into the laparoscopic appendectomy （LA group） and open appendectomy group （OA group）. Each included 80 cases. The lev- els of CRP, IL-6, TNF alpha and WBC were measured before operation, 1, 3 day after operation were recorded. Operative duration, postoperative time for intestinal function recovery, hospital stay, hospital cost and postoperative complications were also compared between the two groups. Results The intestinal function recovery time and hospital stay were markedly shorter in the LA group than in the OA group （ P 〈 0.01 ）. The circulating levels of the CRP, IL-6, TNF alpha and WBC were lower 1 and 3 days after operation in the LA group than those in the OA group （ all P 〈 0.01 ）. No complications occured in the two groups. Conclusion LA proves to have less impact on body injury than LA by protecting the immune function and assisting in the postoperative recovery.

关 键 词：急性阑尾炎 阑尾切除术 腹腔镜 炎症反应 

分 类 号：R574.61[医药卫生—消化系统]