改良Karl-storz单孔腹腔镜手术治疗急性阑尾炎的疗效及对免疫功能和炎症反应的影响  

Effect of modified Karl-Storz single-port laparoscopic surgery on acute appendicitis and its effect on immune function and inflammatory response

作　　者：梁文杰 黎然 冯疆勉 李卫伶 洪文彬 LIANG Wenjie;LI Ran;FENG Jiangmian(Department of Gastrointestinal Surgery,Yangjiang People's Hospital,Guangdong,Yangjiang 529500,China)

机构地区：[1]广东省阳江市人民医院胃肠外科,529500

出　　处：《临床外科杂志》2022年第12期1155-1158,共4页Journal of Clinical Surgery

摘　　要：目的探讨改良Karl-storz单孔腹腔镜手术治疗急性阑尾炎的临床疗效及对病人免疫功能和炎症反应的影响。方法2019年8月~2020年1月收治的急性阑尾炎病人78例,根据治疗方式的不同分为两组,观察组40例,采用改良Karl-storz单孔腹腔镜手术;对照组38例,采用传统腹腔镜手术。比较两组病人围术期指标、免疫功能指标、炎症因子指标、疼痛指数以及并发症情况。结果观察组与对照组的手术时间分别为(47.26±6.33)分钟和(45.87±6.28)分钟,拔管时间分别为(2.15±0.84)小时和(2.23±0.89)小时,术后卧床时间分别为(16.46±4.37)小时和(17.82±4.51)小时,两组比较差异无统计学意义(P>0.05);观察组术中出血量为(16.24±3.11)ml,术后肠功能恢复时间(12.14±1.56)小时,住院时间(4.91±1.43)天,对照组分别为(20.15±3.26)ml、(13.85±1.67)小时和(6.02±1.58)天,两组比较差异有统计学意义(P<0.05)。两组间术前1天和术后7天的CD3+、CD4+、CD8+水平及CD4+/CD8+比值比较无统计学差异(P>0.05)。术后1天时观察组CD3+、CD4+、CD8+及CD4+/CD8+比值与对照组比较差异有统计学意义(P<0.05)。两组术前1天时血清炎性因子TNF-α、IL-6、IL-8、CRP水平比较,差异无统计学意义(P>0.05)。术后3天时两组病人血清血清炎性因子水平均高于术前,且观察组血清炎性因子水平低于对照组,差异有统计学意义(P<0.05)。观察组术后1小时、24小时、36小时、48小时、72小时的VAS评分均显著低于对照组,差异有统计学意义(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论与传统腹腔镜阑尾切除术相比,改良Karl-storz单孔腹腔镜手术治疗急性阑尾炎疗效显著。Objective To investigate the clinical efficacy of modified Karl-Storz single-port laparoscopic surgery for acute appendicitis and its effect on immune function and inflammatory response.Methods A total of 78 patients with acute appendicitis admitted to our hospital from August 2019 to January 2020 were selected.According to the different treatment methods,they were divided into the observation group with modified Karl-Storz single-port laparoscopic surgery(n=40)and the control group with traditional laparoscopic surgery(n=38).The perioperative index,immune function index,pain index and complications were compared in the two groups.Results The operation time and the extubation time in the observation group and the control group were(47.26±6.33)min and(45.87±6.28)min,(2.15±0.84)h and(2.23±0.89)h,respectively.The bed rest time was(16.46±4.37)h and(17.82±4.51)h after operation,respectively.There was no significant difference between the two groups(P>0.05).The amount of intraoperative bleeding in the observation group was(16.24±3.11)ml,the time to recovery of intestinal function was(12.14±1.56)h,and the duration of hospitalization was(4.91±1.43)d,while that in the control group was(20.15±3.26)ml,(13.85±1.67)h and(6.02±1.58)d,respectively(P<0.05).There was no significant difference in the levels of CD3+,CD4+,CD8+and the ratio of CD4+/CD8+between the two groups 1d before operation and 7d after operation(P>0.05).On day 1 after surgery,the ratios of CD3+,CD4+,CD8+and CD4+/CD8+in the observation group were significantly different from those in the control group(P<0.05).There were no statistical difference in serum levels of inflammatory factors TNF-α,IL-6,IL-8,and CRP at 1d before surgery(P>0.05).Higher serum inflammatory factors in both groups at 3d later than preoperative(P<0.05),and the serum levels in the observed group were significantly lower than the control group(P<0.05).The VAS scores of the observation group at 12 h,24 h,36 h,48 h and 72 h after operation were significantly lower than those of the co

关 键 词：急性阑尾炎 Karl-storz 腹腔镜阑尾切除术 临床疗效 免疫功能 炎症反应 

分 类 号：R656.8[医药卫生—外科学]