早期微创手术治疗重症急性胰腺炎对免疫功能的影响及临床效果  

Influence on immune function and clinical effect of early minimally invasive surgery for severe acute pancreatitis

作　　者：陈明[1] 王旭林[1] 邢人伟[1] 兰勇 凌乙升 CHEN Ming;WANG Xu-lin;XING Ren-wei;LAN Yong;LING Yi-sheng(Department of Hepatobiliary Surgery,Taizhou Municipal Hospital,Taizhou University Medical School,Zhejiang Taizhou 318000,China)

机构地区：[1]浙江省台州学院医学院附属市立医院肝胆外科

出　　处：《中国医刊》2019年第9期962-965,共4页Chinese Journal of Medicine

基　　金：国家自然科学基金（81072207/H1625）;国家高技术研究发展计划（863计划）（2004AA227070）;台州市科技计划项目（100ky-26）

摘　　要：目的 探讨早期微创手术治疗重症急性胰腺炎对患者免疫功能的影响及临床效果。方法 回顾性分析2014年2月至2016年9月浙江省台州学院医学院附属市立医院收治的94例重症急性胰腺炎患者的病例资料。94例患者根据治疗方法不同分为对照组和观察组,每组47例。对照组患者采用传统保守治疗,观察组患者采用早期微创手术治疗,比较分析两组患者的临床治疗效果、免疫功能变化及并发症发生情况。结果 观察组的治疗总有效率为93.62%,明显高于对照组的70.12%,差异有显著性(P<0.05)。治疗前,两组患者的血清淀粉酶、尿淀粉酶、白细胞计数、肿瘤坏死因子α水平比较差异无显著性(P>0.05),治疗第7、14天时,两组上述指标均较治疗前明显降低,且观察组明显低于对照组,差异有显著性(P<0.05)。两组治疗前CD4^+、CD8^+T细胞数及CD4/CD8比值差异无显著性(P>0.05),治疗后CD4^+T细胞数及CD4/CD8比值明显升高,且观察组明显高于对照组,而CD4^+T细胞数明显降低,且观察组明显低于对照组,差异有显著性(P<0.05)。观察组患者并发症发生率为10.64%,明显低于对照组的29.79%,差异有显著性(P<0.05)。结论 早期微创手术治疗重症急性胰腺炎疗效较好,可明显提高患者的免疫功能,且操作简单、并发症少,但需要严格掌握手术时机,满足手术适应证。Objective To investigate the clinical effect of early minimally invasive surgery for severe acute pancreatitis and its influence on immune function of patients.Method The clinical data of 94 patients with severe acute pancreatitis admitted to the Municipal Hospital Affiliated to the Medical College of Taizhou University from February 2014 to September 2016 were retrospectively analyzed.94 patients were divided into control group and observation group according to different treatment methods,47 cases in each group.Patients in the control group were treated with traditional conservative treatment,while patients in the observation group were treated with early minimally invasive surgery.The clinical efficacy,immune function changes and complications of the two groups were compared and analyzed.Result The total effective rate of the observation group was 93.62%,which was significantly higher than that of the control group(70.12%),the difference was significant(P<0.05).Before treatment,there was no significant difference in serum amylase,urinary amylase,leukocyte count and tumor necrosis factor-alpha between the two groups(P>0.05).On the 7th and 14th day of treatment,the above indexes in the two groups were significantly lower than those before treatment,and the observation group was significantly lower than that in the control group(P<0.05).There was no significant difference in the number of CD4^+,CD8^+T cells and CD4/CD8 ratio between the two groups before treatment(P>0.05).After treatment,the number of CD4^+T cells and CD4/CD8 ratio increased significantly,and the number of CD4^+T cells in the observation group was significantly higher than that in the control group,while the number of CD4^+T cells in the observation group was significantly lower than that in the control group,and the difference was significant(P<0.05).The incidence of complications in the observation group was 10.64%,which was significantly lower than 29.79%in the control group(P<0.05).Conclusion Early minimally invasive surgery for severe acute

关 键 词：微创手术 重症急性胰腺炎 血清淀粉酶 白细胞计数 免疫功能 

分 类 号：R657.51[医药卫生—外科学]