完全腹膜外腹腔镜疝修补术与开放疝修补术对腹股沟斜疝老年病人术后应激、免疫功能及近期生活质量的影响  

Effects of total extraperitoneal herniorrhaphy and open hernioplasty on stress, immune function and short-term quality of life in elderly patients with indirect inguinal hernia

作　　者：钟志强 曾繁增 朱蔷 宋小康 ZHONG Zhiqiang;ZENG Fanzeng;ZHU Qiang;SONG Xiaokang(Department of Surgery,The Third People's Hospital,Meizhou,Guangdong 514021,China;Department of General Surgery,Yuedong Hospital,The Third Affiliated Hospital of Zhongshan University,Meizhou,Guangdong 514000,China)

机构地区：[1]梅州市第三人民医院外科,广东梅州514021 [2]中山大学附属第三医院粤东医院普外科一区,广东梅州514000

出　　处：《安徽医药》2022年第12期2474-2479,共6页Anhui Medical and Pharmaceutical Journal

基　　金：梅州市社会发展科技计划项目(181229162051576)。

摘　　要：目的 研究完全腹膜外腹腔镜疝修补术(TEP)与开放疝修补术对腹股沟斜疝老年病人术后应激、免疫功能及近期生活质量的影响。方法 采用便利抽样法选取2019年3—12月梅州市第三人民医院腹股沟斜疝病人92例,采用TEP病人51例为观察组、开放疝修补术病人41例为对照组。观察两组病人术中情况、术后恢复情况,术前、术后24 h和术后72 h时应激水平、免疫功能变化及术后1个月生活质量。结果 两组病人均顺利完成手术,对照组手术时间短于观察组[(41.64±7.22)min比(59.43±11.91)min],观察组术后尿管拔除时间、下床活动时间及住院时间均少于对照组[(9.21±2.43)h比(15.62±3.94)h,(6.42±2.73)h比(11.95±4.24)h,(5.74±1.32)d比(6.42±1.75)d],术后并发症发生率低于对照组(1.96%比14.63%),均差异有统计学意义(P<0.05)。时间因素对两组病人皮质醇、肾上腺素、去甲肾上腺素(NA)及CD4阳性T淋巴细胞(CD4^(+))、CD8阳性T淋巴细胞(CD8^(+))、CD4^(+)/CD8^(+)的影响均差异有统计学意义(P<0.05)。两组术后24 h时皮质醇、肾上腺素、NA及CD8^(+)[观察组:(155.58±24.31)μg/L、(2.60±0.53)μg/L、(3.94±0.79)μg/L、(27.14±3.92)%,对照组:(158.35±26.56)μg/L、(2.63±0.51)μg/L、(3.99±0.81)μg/L、(27.92±3.15)%]均明显高于术前[观察组:(98.25±31.23)μg/L、(2.29±0.44)μg/L、(3.43±0.74)μg/L、(21.82±2.60)%,对照组:(97.55±32.35)μg/L、(2.27±0.42)μg/L、(3.40±0.71)μg/L、(21.90±3.31)%]、术后72 h[观察组:(99.80±29.16)μg/L、(2.31±0.42)μg/L、(3.44±0.72)μg/L、(22.07±2.90)%,对照组:(101.27±29.58)μg/L、(2.32±0.44)μg/L、(3.46±0.74)μg/L、(23.22±3.74)%]时,CD4~+、CD4~+/CD8~+[观察组:(16.83±2.74)%、0.62±0.22,对照组:(17.86±2.04)%、0.64±0.13]明显低于术前[观察组:(26.84±3.09)%、1.23±0.17,对照组:(26.72±3.26)%、1.22±0.16]、术后72 h[观察组:(24.50±3.60)%、1.11±0.14,对照组:(25.10±4.05)%、1.08±0.14]时,差异有统计学意义(P<0.05)。两�Objective To study the effects of total extraperitoneal herniorrhaphy(TEP) and open hernioplasty on stress,immunity and short-term quality of life in elderly patients with indirect inguinal hernia.Methods A total of 92 patients with indirect inguinal hernia undergoing surgery in the Third People’s Hospital of Meizhou from March to December 2019 were selected by convenience sampling method,and 51 TEP patients were used as observation group and 41 patients control group.An observation was made of the intraoperative and postoperative conditions of the patients.The changes of stress level,immune function and quality of life in one month were observed before operation,24 hours after operation and 72 hours after operation.Results Both groups successfully completed the operation.The operation time of the control group was shorter than that of the observation group [(41.64±7.22) min vs.(59.43±11.91)min],the time of catheter removal,ambulation time and hospital stay in the observation group were less than those in the control group [(9.21±2.43)h vs.(15.62±3.94)h,(6.42±2.73)h vs.(11.95±4.24)h,(5.74±1.32)d vs.(6.42±1.75)d],and postoperative complication rate in the observation group was lower than that in the control group(1.96% vs.14.63%);the differences had statistical significance(P<0.05).The influence of time factor on cortisol(Cor),adrenalin(AD),norepinephrine(NA),CD4^(+),CD8^(+)and the ratio of CD4^(+)to CD8^(+)T lymphocytes(CD4^(+)/CD8^(+))in the two groups had statistically significant differences(P<0.05).Cor,AD,NA and CD8at 24 hours after operation in both groups [observation group:(155.58±24.31)μg/L,(2.60±0.53)μg/L,(3.94±0.79)μg/L,(27.14±3.92)%;control group:(158.35±26.56)μg/L,(2.63±0.51)μg/L,(3.99±0.81)μg/L,(27.92±3.15)%] were significantly higher than those before operation [observation group:(98.25±31.23)μg/L,(2.29±0.44)μg/L,(3.43±0.74)μg/L,(21.82±2.60)%;control group:(97.55±32.35)μg/L,(2.27±0.42)μg/L,(3.40±0.71)μg/L,(21.90±3.31)%],72 hours after operation [observation grou

关 键 词：疝 腹股沟 完全腹膜外腹腔镜疝修补术 开放疝修补术 应激 免疫功能 生活质量 老年人 

分 类 号：R656.21[医药卫生—外科学]