腹腔镜与开腹手术治疗老年胃十二指肠溃疡穿孔的疗效及对COX-2、NF-κB、IL-8、IL-17表达的影响  

Efficacy of laparoscopy and open abdominal surgery on elderly patients with gastroduodenal ulcer perforation and on the expressions of COX-2,NF-κB,IL-8 and IL-17

作　　者：刘猛 张如山 邹大朋 马海云 李昕 张佛生 李增军[2] Liu Meng;Zhang Rushan;Zou Dapeng;Ma Haiyun;Li Xin;Zhang Fosheng;Li Zengjun(Department of General Surgery,Miyun Teaching Hospital,Capital Medical University,Beijing 101500,China)

机构地区：[1]首都医科大学密云教学医院,北京101500 [2]山东省医学科学院山东肿瘤医院

出　　处：《海军医学杂志》2020年第1期46-50,共5页Journal of Navy Medicine

基　　金：山东省科技发展计划项目(gsf11834)

摘　　要：目的探讨腹腔镜与开腹手术治疗老年胃十二指肠溃疡穿孔的疗效及对环氧化酶 2(cyclooxygenase 2,COX 2)、核因子 κB(nuclear factor kappa binding,NF κB)、白细胞介素(IL) 8和IL 17表达的影响。方法选择2013年8月至2017年2月在首都医科大学密云教学医院普外科诊治的老年胃十二指肠溃疡穿孔患者144例作为研究对象,按照入院顺序分为观察组与对照组,每组72例,观察组给予腹腔镜修复治疗,对照组给予开腹手术修补治疗,记录2组疗效与血清COX 2、NF κB、IL 8、IL 17水平的变化情况。结果全部患者手术顺利完成,手术中均未见并发症,2组患者手术时间比较,差异无统计学意义(P>0.05),观察组在手术中的出血量及术后肠功能恢复周期、排气时间、住院天数等均显著优于对照组(P<0.05)。观察组与对照组手术后14 d产生并发症(腹腔感染、切口感染、肺部感染、肠梗阻等)概率分别为2.8%和15.3%,观察组显著低于对照组(P<0.05)。2组患者术后14 d的COX 2、NF κB、IL 8、IL 17水平较术后1 d显著降低,观察组也显著低于对照组(P<0.05)。随访至今,观察组的中位生存时间与1年生存率分别为(47.44±6.44)个月与100.0%(72/72),而对照组分别为(34.98±5.29)个月与90.3%(65/72),2组比较差异均有统计学意义(P<0.05)。结论和开腹手术相比,腹腔镜手术在治疗老年胃十二指肠溃疡穿孔可抑制炎症因子的表达,能减少手术创伤与术后并发症的发生,从而促进患者康复与延长生存时间。Objective To investigate the efficacy of laparoscopy and open abdominal surgery on the elderly patients with gastroduodenal ulcer perforation and on the expressions of cyclooxygenase 2(COX 2),nuclear factor kappa binding(NF κB),IL 8 and IL 17.Methods One hundred and forty four elderly patients with gastroduodenal ulcer perforation admitted into the Department of General Surgery,Miyun Teaching Hospital,Capital Medical University from August 2013 to February 2017,were recruited as research subjects.The patients were randomly divided into the observation group and the control group in accordance with order of admission,each consisting of 72 patients.The observation group was given laparoscopic repair,while the control group received open surgery.Curative effects and changes in the levels of COX 2,NF κB,IL 8 and IL 17 were recorded for the 2 groups.Results All patients successfully completed surgery and no complications occurred.Though the length of surgery was long for the patients of the 2 groups,no statistical significance could be noted,when comparisons were made between them(P>0.05).Loss of blood,recovery time of intestinal function after surgery,first anal exhaust and days of hospitalization in the observation group were all significantly superior to those of the control group(P<0.05).Fourteen days after surgery,rates of complications(abdominal infection,incision infection,pulmonary infection and intestinal obstruction)for the observation group and the control group were 2.8% and 15.3%respectively,with the former being obviously lower than the latter(P<0.05).Fourteen days after surgery,the levels of COX 2,NF κB,IL 8 and IL 17 in the 2 groups all significantly decreased than those one day after surgery,and the observation group was also significantly lower than the control group(P<0.05).Latest medical follow up showed that the median survival time and 1 year survival time of the observation group were(47.44±6.44)months and 100%(72/72),while those of the control group were(34.98±5.29)months and 90.3%(65/72).

关 键 词：腹腔镜 老年人 胃十二指肠溃疡穿孔 环氧化酶 2 核因子 ΚB 

分 类 号：R656.62[医药卫生—外科学]