胆源性胰腺炎不同手术治疗时机对机体应激和免疫功能的影响  

Effects of different timing of operation on stress and immune function in patients with biliary pancreatitis

作　　者：张阳光[1] 郭忠[1] Zhang Yangguang;Guo Zhong(Department of Surgery,the Third People’s Hospital of Guangyuan City,Guangyuan 628001,China)

机构地区：[1]四川省广元市第三人民医院外一科,628001

出　　处：《中华普通外科学文献（电子版）》2018年第4期242-245,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的探讨胆源性胰腺炎(BP)患者不同临床手术时机行腹腔镜胆囊切除术(LC)对机体应激状态、炎症因子及免疫功能的影响。方法回顾性分析2013年12月至2017年12月间在广元市第三人民医院接受治疗轻症非梗阻型BP患者156例,根据患者手术时机将其分成早期手术组(发病72 h内进行手术)81例和择期手术组(发病7周左右且病情稳定再进行手术)75例。比较两组患者手术资料及相关并发症和复发状况,检测术前和术后1、3 d血清白细胞介素6(IL-6)、C反应蛋白(CRP)、促肾上腺皮质激素(ACTH)及皮质醇(Cor)水平以及血清T淋巴细胞亚群水平变化。结果两组患者术后住院时间、留置引流管数、中转开腹数以及术后平均引流量比较,差异均无统计学意义;但择期手术组患者手术时间及术中出血量低于早期手术组,差异有统计学意义(t=5.748、12.888,均P<0.01)。术后1 d时两组患者血清IL-6、CRP、Cor及ACTH水平较术前升高,术后3 d时的水平显著低于术后1 d;术后1 d时两组患者血清CD3^+、CD4^+、CD8^+及CD4^+/CD8^+较术前降低,术后3 d时的水平较术后1 d时显著升高,差异均有统计学意义(P<0.05),两组术后1、3 d时机体应激和免疫功能比较,差异无统计学意义。两组患者并发症发生率、复发率比较,差异无统计学意义(χ~2=0.184、0.005,P=0.668、0.946)。结论与择期手术相比,早期手术并不会增加轻症非梗阻型BP患者的手术难度和并发症发生概率,临床疗效同样理想。Objective To investigate the effects of different timing of laparoscopic cholecystectomy(LC)on the stress state,inflammatory factors and immune function in patients with biliary pancreatitis(BP).Methods From December 2013 to December 2017,one hundred and fifty-six patients with mild non-obstructive BP treated in the Third People’s Hospital of Guangyuan City were retrospective analyzed.According to the timing of the operation,they were divided into early surgery group(operation within 72 h of tillness,81 cases)and elective surgery group(surgery after 7 weeks of illness with a disease stability,75 cases).The operation related complications and recurrence were compared between the two groups.Serum level changes of interleukin-6(IL-6),C-reactive protein(CRP),adrenocorticotropic hormone(ACTH),cortisol(Cor),and T lymphocyte subsets were measured preoperatively and 1,3 days after surgery.Results There were no significant differences in postoperative hospitalization time,number of indwelling drainage tube,conversion to open surgery and postoperative drainage volume between the two groups.The operation time and blood loss in elective surgery group were lower than early surgery group(t=5.748,12.888,both P<0.01).The serum levels of IL-6,CRP,Cor and ACTH at 1 d after operation in the two groups were higher than those before operation,and the levels at 3 d after operation were significantly lower than those of 1 d after operation(P<0.05).However,the changes in the level of T lymphocyte subsets were opposite(P<0.05).There was no significant difference in stress and immune function between the two groups at 1 and 3 d after operation.There were no significant differences in complication rate and recurrence rate between the two groups(χ2=0.184,0.005,P=0.668,0.946).Conclusion Compared with elective surgery,early surgery does not increase the surgical difficulty and probability of complications in patients with mild non-obstructive gallstone pancreatitis,and the clinical efficacy is equally satisfactory.

关 键 词：胰腺炎 胆囊切除术 腹腔镜 手术时机 应激反应 

分 类 号：R657.51[医药卫生—外科学]