腹腔镜技术在结直肠穿孔患者治疗中对机体应激反应、安全性及近期结局的影响  

Effects of laparoscopic surgery on systemic stress response and recent clinical outcomes for the acute perforation of colorectum patients

作　　者：王希[1] 袁乐生 刘习红[1] 李文煜[1] 肖凌晖[1] 曾惠明[1] 王骅[1] 谢维[1] 

机构地区：[1]惠州市第一人民医院胃肠外科,广东惠州516003 [2]博罗县第二人民医院普通外科,广东惠州516157

出　　处：《岭南现代临床外科》2017年第6期669-673,共5页Lingnan Modern Clinics in Surgery

基　　金：惠州市科技计划项目(20160802)

摘　　要：目的探讨腹腔镜手术在处理结直肠穿孔中对机体应激反应、安全性及近期结局的影响。方法回顾分析2013年2月至2017年5月在我院收治的结直肠穿孔患者78例,术中根据患者腹部情况,除有明显腹胀、反复腹部手术史、不能耐受气腹者,均先行腹腔镜探查,再根据腹腔条件、George腹腔污染分级、病灶局部情况及全身情况决定手术方式,将患者是否在腹腔镜下完成手术作为研究因素,分为腹腔镜组(n=43)和开腹组(包括直接开腹+中转开腹病例)(n=35)。比较两组患者临床指标,包括:BMI、手术时间、术中出血,排气时间、术后并发症(肺部感染、尿潴留、深静脉血栓、切口感染、泌尿系感染)的发生情况,临床结局、术后住院时间以及两组患者围手术期C反应蛋白(CRP)、胰岛素抵抗指标的变化情况。结果所有患者均顺利完成手术,无术中死亡病例,与开腹组相比,腹腔镜组在术后首次排气时间、术后住院时间方面均明显减少(P<0.05)。比较两组患者术后并发症发生情况,在肺部感染、伤口感染、泌尿系感染、深静脉血栓方面,腹腔镜组较开腹组明显减少,差异具有统计学意义(P<0.05)。腹腔镜组CRP、胰岛素抵抗指数恢复情况在术后第3 d及第7 d较开腹组理想,差异具有统计学意义(P<0.05)。结论在可腹腔镜探查的前提下,对于腹腔条件好、污染程度轻的结直肠穿孔病例,腹腔镜下完成手术安全,创伤小,机体炎症反应和应激反应轻。Objective To evaluate the effect of laparoscopy operation on systemic stress response and recent clinical outcomes for the patients with acute colorectal perforation. Methods Seventy-eight patients received surgery for the acute colorectal perforation. Based on whether accomplished by laparoscopy,the patients were divided into two groups:laparoscopy group(n=43)and laparotomy group(n=35). C-reactive protein(CRP),insulin resistance(IR)in 78 patients were assayed preoperatively and postoperatively on the first day,third day and seventh day. The average length of postoperative hospital stays,the postoperative complications,the time of first flatus were recorded respectively. Results All surgical procedures were completed smoothly,and no case died. The levels of CRP & IR on 3 rd,7 th day postoperative in patients of laparoscopy group were significantly decreased than in laparotomy group(P<0.05). The infectious complications and the occurrence of deep venous thrombosis in patients of laparoscopy group were significantly lower than in laparotomy group(P<0.05). The time to first flatus and the length of postoperative hospital stay in patients of laparoscopy group were significantly shorter than those in the laparotomy group(all P values <0.05). Conclusion Laparoscopy for the patients with acute colorectal perforation was safe and reliable. Laparoscopic surgery could significantly accelerate recovery of postoperative systemic stress response,release the incidence of postoperative complications and shorten the length of postoperative hospital stay.

关 键 词：腹腔镜 结直肠穿孔 应激 近期结局 

分 类 号：R657.1[医药卫生—外科学]