腹腔镜下胃十二指肠球部溃疡穿孔修补术与开腹手术的比较研究  

Laparoscopic versus open repair of gastroduodenal ulcer perforation

作　　者：宋留龙 王立胜[1] 董晓强[2] 

机构地区：[1]江苏省盐城市第三人民医院普外科,江苏盐城224001 [2]苏州大学附属第一医院普外科,江苏苏州215006

出　　处：《中国现代普通外科进展》2016年第6期455-459,共5页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨腹腔镜下胃十二指肠球部溃疡穿孔修补术与开腹手术对患者机体的影响作用机制。方法:2008年8月-2013年5月江苏省盐城市第三人民医院普外科行胃、十二指肠球部溃疡穿孔修补术患者58例,其中30例行腹腔镜下胃、十二指肠球部溃疡穿孔修补术,28例行开腹胃十二指肠球部溃疡穿孔修补术,分析两组患者的临床资料及实验数据。结果:1)术后肠功能恢复时间、住院时间、术后抗生素使用时间等方面,腹腔镜组明显优于开腹组。2)腹腔镜组患者外周血WBC计数、CRP水平等炎症指标水平显著低于开腹组。3)ELISA检测显示,腹腔镜组患者血清IL-6和TNF-α炎症因子水平明显低于开腹组。4)腹腔镜手术对患者T淋巴细胞亚群分布影响小于开腹组,表明腹腔镜组患者机体细胞免疫状态较稳定。结论:腹腔镜下行胃十二指肠球部溃疡修补术对机体造成轻微的创伤,对脏器干扰小,全身炎症反应程度轻,对机体细胞免疫功能干扰少,并发症少,更有利于患者的恢复,是一种安全有效的手术方式。Objective： To evaluate the influence of laparoscopic versus open repair for perfo- rated peptic ulcers and the main mechanisms. Methods： Fifty-eight patients with peptic ulcer per- foration in gastroinstestinal department of Yancheng Third People＇s Hospital were enrolled in our study from August 2008 to May 2013, including 30 patients treated with laparoscopic repair and 28 patients with open repair. Clinical data of patients in two groups were analyzed retrospectively. Resuits： 1.Statistical analysis of clinical data revealed that laparoscopic perforation repair had more benefits than open perforation repair in recovery time of intestinal function, hospitalization time, using time of postoperative antibiotic, and so on.2.Levels of inflammatory markers in patients who under- went laparoscopic perforation repair, such as WBC and CRP, were significantly lower than that in pa- tients who underwent open perforation repair.3.The results of ELISA showed that serum levels of in- flammatory factors IL-6 and TNF- a were dramatically lower in patients in laparoscopic repair group, compared with that in open repair group.4.The results of flow cytometry revealed that laparoscopic foration repair influenced the distribution of T-lymphocyte subpopulation more than open foration re- pair, and demonstrated that cellular immune status of patients in laparoscopic repair group was more stable and better than that in the open repair group. Conclusion： Laparoscopic repair of gastroduo- denal ulcer perforation was considered as a safe and effective method, and worth to be used in clini- cal practice, because of minor trauma to the body, less influences on organs and inflammatory reac- tions, fewer complications, and more conductive to the rehabilitation of patients.

关 键 词：腹腔镜 穿孔修补术 胃十二指肠球部溃疡穿孔 细胞免疫 

分 类 号：R573.1[医药卫生—消化系统]