老年上消化道穿孔患者行腹腔镜下修补术对血清炎性细胞因子、细胞免疫指标的影响  

Effects of laparoscopic surgery on cellular immune markers and inflammatory mediators in elderly patients with upper gastrointestinal perforation

作　　者：姚正顺 闫鸿 甄博 于鸿泽 刘春勇 YAO Zhengshun;YAN Hong;ZHEN Bo;YU Hongze;LIU Chunyong(Department of Emergency Surgery,Chinese 202 Hospital of PLA,Shenyang 110003,China)

机构地区：[1]中国人民解放军第202医院急诊外科,沈阳110003

出　　处：《疑难病杂志》2018年第4期366-369,373,共5页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨老年上消化道穿孔患者行腹腔镜下修补术对血清炎性细胞因子、细胞免疫指标的影响。方法选择2014年6月—2017年6月解放军第202医院急诊外科就诊的老年上消化道穿孔患者94例作为研究对象,按照手术方式的不同分为观察组和对照组47例。所有患者均给予常规检查,对照组采用传统开腹行修补手术治疗,观察组采用腹腔镜下行修补手术治疗。比较2组患者手术一般情况、术后12 h、48 h疼痛程度及镇痛药物使用率;比较术前、术后7 d IL-6、CRP、TNF-α、CD3+、CD4+、CD8+水平,并记录2组患者术后不良反应发生情况。结果观察组在切口长度、术中出血量、手术时间、下床时间、胃肠道功能恢复时间、住院时间明显低于对照组(t=45.504、25.273、37.850、25.299、56.291、6.991,P均=0.000);观察组术后12 h、48 h VAS评分及镇痛剂使用率明显低于对照组(t=13.385、8.565,χ~2=18.729,P均=0.000);术后7 d观察组IL-6、CRP、TNF-α明显低于对照组,CD3^+、CD4^+、CD8^+水平显著高于对照组(t=6.123、4.574、1.759、5.118、5.995、7.964,P均=0.0000);观察组术后肺部感染、切口感染、切口疝、胃肠道瘘、肠梗阻不良反应发生率明显低于对照组(χ~2=6.075、6.612、4.080、4.080、4.620,P=0.014、0.010、0.043、0.043、0.032)。结论老年上消化道穿孔患者行腹腔镜下修补术对机体创伤小,疼痛轻,细胞免疫功能影响小,应激反应轻,并发症少,有利患者术后恢复。Objective To investigate the effect of laparoscopic surgery on cellular immune markers and inflammatory mediators in elderly patients with upper gastrointestinal perforation.Methods Ninety-four cases of elderly patients with upper gastrointestinal perforation were selected,which were treated in hospital from June 2014 to June 2017,and they were divided into observation group(47 cases)and control group(47 cases).The patients of two groups were all treated with routine examination and treatment.The patients of control group were treated with traditional open surgery.The patients of observation group were treated with laparoscopic surgery.Compare the general condition of surgery,postoperative 12 h,48 h pain,analgesic drug use,adverse reactions and changes of IL 6,CRP,TNF-α,CD3+,CD4+,CD8+levels of two groups.Results The incision length,intraoperative blood loss,operation time,time to bed,gastrointestinal function recovery time,length of stay in the observation group were significantly lower than those in the control group(t=45.504,t=25.273,t=37.850,t=25.299,t=56.291,t=6.991;P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000).The postoperative 12 h,48 h pain VAS score,analgesic use rate in the observation group were significantly lower than those in the control group(t/χ2=13.385,t/χ2=8.565,t/χ2=18.729;P=0.000,P=0.000,P=0.000).On the 7th day after operation,the IL 6,CRP,TNF-αlevels in the observation group were significantly lower than those in the control group,and the CD3+,CD4+,CD8+levels in the observation group were significantly higher than those in the control group(t=6.123,t=4.574,t=1.759,t=5.118,t=5.995,t=7.964;P=0.000,P=0.000,P=0.041,P=0.000,P=0.000,P=0.000).There were lung infection,incision infection,incisional hernia,gastrointestinal fistula,intestinal obstruction and other adverse reactions occurred in both two groups,and the difference between groups were statistically significant(χ2=6.075,χ2=6.612,χ2=4.080,χ2=4.620;P=0.014,P=0.010,P=0.043,P=0.043,P=0.032).Conclusion Laparoscopic surgery for the tr

关 键 词：上消化道穿孔 腹腔镜 细胞免疫 炎性介质 老年 

分 类 号：R656[医药卫生—外科学]