腹膜外腹腔镜疝修补术与小切口微创手术对腹股沟疝患儿生理应激、免疫功能的影响  

Effects of extraperitoneal laparoscopic herniorrhaphy and small incision minimally invasive surgery on physiological stress and immune function in children with inguinal hernia

作　　者：尤贞融 施海丹[1] 尚婷婷 YOU Zhenrong;SHI haidan;SHANG Tingting(Operating Room,Taizhou Hospital of Zhejiang Province,Taizhou 317000,Zhejiang,China)

机构地区：[1]浙江省台州医院手术室,浙江台州317000

出　　处：《中国现代医生》2023年第1期11-14,18,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2019KY244)。

摘　　要：目的探讨腹膜外腹腔镜疝修补术与小切口微创手术对腹股沟疝患儿生理应激、免疫功能的影响。方法选取2018年7月至2019年7月于浙江省台州医院就诊的104例腹股沟疝患儿,按照完全随机法将其分为对照组和观察组,每组各52例。对照组患儿行小切口微创手术,观察组患儿行腹膜外腹腔镜疝修补术。比较两组患儿的手术时间、住院时间、首次排气时间、下床活动时间、术中失血量、疼痛视觉模拟评分法(visual analogue scale,VAS)评分、皮质醇(cortisol,Cor)、去甲肾上腺素(norepinephrine,NE)、CD3、CD4、临床疗效和并发症发生情况。结果两组患儿的手术时间比较,差异无统计学意义(P>0.05);观察组患儿的术中失血量显著少于对照组(P<0.05),住院时间、首次排气时间、下床活动时间均显著短于对照组(P<0.05)。术后1d、7d,两组患儿的VAS评分、Cor、CD4水平均显著低于本组术前,NE、CD3水平均显著高于本组术前(P<0.05),且观察组患儿术后的VAS评分、Cor、CD4水平均显著低于对照组,NE、CD3水平均显著高于对照组(P<0.05)。观察组患儿的总有效率显著高于对照组(χ^(2)=8.914,P=0.028)。观察组患儿的总并发症发生率显著低于对照组(χ^(2)=5.862,P=0.015)。结论腹膜外腹腔镜疝修补术的临床疗效优于小切口微创手术,可有效减轻患儿疼痛,降低术后并发症发生率,对氧化应激的影响较小,可改善患儿的免疫功能,促进术后快速恢复。Objective To study the effects of extraperitoneal laparoscopic herniorrhaphy and small incision minimally invasive surgery on physiological stress and immune function in children with inguinal hernia.Methods A total of 104 children with inguinal hernia who visited Taizhou Hospital of Zhejiang Province from July 2018 to July 2019 were selected and divided into control group and observation group according to the complete random method,with 52 cases in each group.The children in control group were treated with small incision minimally invasive surgery,and the children in observation group were treated with extraperitoneal laparoscopic herniorrhaphy.The operation time,hospital stay,first exhaust time,ambulation time,intraoperative blood loss,pain visual analog score(VAS)score,cortisol(Cor),noradrenaline(NE),CD3,CD4,clinical efficacy and complications were compared between the two groups.Results There was no significant difference in operation time between the two groups(P>0.05).The intraoperative blood loss in observation group was significantly less than that in control group(P<0.05),hospital stay,first exhaust time,ambulation time were significantly shorter than those in control group(P<0.05).One day and seven days after surgery,VAS score,Cor and CD4 levels in both groups were lower than those before surgery,the NE and CD3 levels were higher than those those before surgery(P<0.05),and VAS score,Cor and CD4 levels in observation group were significantly lower than those of control group,and NE and CD3 levels were significantly higher than those of control group(P<0.05).The total response rate of the children in observation group was significantly higher than that in control group(χ^(2)=8.914,P=0.028).The overall complication rate of the children in observation group was significantly lower than that in control group(χ^(2)=5.862,P=0.015).Conclusion The clinical efficacy of peritoneal laparoscopic herniorrhaphy is superior to small incision minimally invasive surgery,which can effectively reduce pain in children,re

关 键 词：腹膜外腹腔镜疝修补术 疝 生理应激 免疫功能 

分 类 号：R726.1[医药卫生—儿科]