传统开腹和腹腔镜手术对急性阑尾炎患者临床疗效、胃肠功能以及并发症的影响  

Effects of Traditional Open Surgery and Laparoscopic Surgery on Clinical Efficacy, Gastrointestinal Function and Complications in Patients with Acute Appendicitis

作　　者：袁博[1] 张岚[3] 唐海灵[2] 马小安[1] 王重民[1] 慕喜喜 YUAN Bo;ZHANG Lan;TANG Hai-ling;MA Xiao-an;WANG Chong-min;MU Xi-xi(The Second Department of General Surgery,Central Hospital of Xi'an,Xi'an 710003,China;Department of Digestive Tract Diseases,Central Hospital of Xi'an,Xi'an 710003,China;Department of Pediatrics,the Second Affiliated of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安市中心医院普外二科,西安710003 [2]西安市中心医院消化科,西安710003 [3]西安交通大学第二附属医院儿科,西安710004

出　　处：《解放军医药杂志》2019年第12期85-89,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：陕西省重点研发计划项目(2018SF-083)

摘　　要：目的探究开腹与腹腔镜手术治疗急性阑尾炎(AA)的临床效果。方法回顾性分析2005年1月—2015年12月收治的1190例AA患者的临床资料,根据治疗术式分为腹腔镜组630例(包括单纯性422例、化脓性169例、坏疽性39例)与开腹组560例(包括单纯性109例、化脓性336例、坏疽性115例)。比较术前及术后3 d,2组相同病理类型患者的血浆胃肠激素、血清炎性因子水平变化,分析2组相同病理类型患者的围术期指标及术后并发症发生情况。结果术后3 d时,2组血浆胃泌素、胆囊收缩素水平均较术前下降,且相同病理类型腹腔镜组高于开腹组(P<0.05);术后3 d时,2组血浆血管活性肠肽以及血清超敏-C反应蛋白、白介素-6、肿瘤坏死因子-α水平均较术前升高,且相同病理类型腹腔镜组低于开腹组(P<0.05)。腹腔镜组单纯性AA患者手术时间短于开腹组,坏疽性AA患者手术时间长于开腹组(P<0.05);相同病理类型腹腔镜组术中出血量、肛门排气时间、排便时间、停抗生素时间、出院时间均少于开腹组(P<0.05)。腹腔镜组单纯性和化脓性AA患者并发症总发生率低于开腹组(P<0.05)。结论所有病理类型的AA患者行腹腔镜手术均可获得较传统开腹手术更理想的疗效,并能在术后更快恢复胃肠功能,对降低并发症发生风险有利。Objective To investigate clinical effectiveness of open surgery and laparoscopic surgery in treatment of patients with acute appendicitis(AA).Methods Clinical data of 1190 patients with AA was retrospectively analyzed,and the patients were divided into laparoscopic group(n=630,including 422 simple cases,169 suppurative cases,39 gangrenous cases)and open group(n=560,including 109 simple cases,336 suppurative cases,115 gangrenous cases)according to therapeutic methods.In two groups,changes of plasma gastrointestinal hormones and serum inflammatory factors levels were compared among patients with same pathological types before and in the 3 rd d after surgery,and perioperative indexes and incidence rate of complications were analyzed among patients with same pathological types.Results In the 3 rd d after surgery,levels of plasma gastrin and cholecystokinin were lower than those before surgery in two groups,and the levels in laparoscopic group were higher than those in open group in patients with same pathological types(P<0.05);levels of plasma vasoactive intestinal peptide,serum hypersensitive-C-reactive protein,interleukin-6 and tumor necrosis factor-αwere higher than those before surgery in two groups,and the levels in laparoscopic group were lower than those in open group in patients with same pathological types(P<0.05).In laparoscopic group,operative time of patients with simple AA was shorter,while operative time of patients with gangrenous AA was longer than those in open group(P<0.05).Values of intraoperative volume of blood loss,anal exhaust time,defecation time,stop time of using antibiotics and discharge time in laparoscopic group were lower than those in open group of patients with same pathological type(P<0.05).The total incidence rates of complications of patients with simple and suppurative AA in laparoscopic group were lower than those in open group(P<0.05).Conclusion Laparoscopic surgery may achieve more ideal efficacy than traditional open surgery in all pathological types of AA patients,and it may

关 键 词：开腹手术 外科手术 腹腔镜 急性阑尾炎 胃泌素 超敏-C反应蛋白 并发症 

分 类 号：R574.[医药卫生—消化系统]