标题：腹腔镜手术对黏连性肠梗阻患者的应激及炎症指标的影响

      作者：朱宏升，徐亮    城固县医院普通外科，陕西 城固 723200

      卷次： 2019年30卷11期

      【摘要】 目的 探讨腹腔镜手术对黏连性肠梗阻患者的应激及炎症指标的影响。方法 回顾性分析2017年1月至2018年7月城固县医院普通外科收治的94例黏连性肠梗阻患者的临床资料，根据手术方式分为观察组和对照组，每组47例，观察组在腹腔镜下实施手术，对照组实施开腹手术。比较两组患者的围术期情况、应激指标[超氧化物歧化酶 (SOD)、丙二醛 (MDA)]、炎症指标 [肿瘤坏死因子-α (TNF-α)、白介素-6 (IL-6)、超敏 C反应蛋白(hs-CRP)]表达及并发症发生率。结果 观察组和对照组患者的手术时间[(64.93±7.50) min vs (77.81±8.14) min]、切口长度[(3.74±0.45) cm vs (15.96±2.77) cm]、肛门排气时间[(21.73±1.88) h vs (35.07±2.59) h]、下床活动[(25.02±1.75) h vs(40.95±2.74) h]及住院时间[(4.29±0.60) d vs (8.83±1.21) d]比较，观察组均短于对照组，术中出血量[(64.41±7.03) mLvs (116.63±14.87) mL]比较，观察组少于对照组，差异均有统计学意义(P<0.05)；两组患者术前1 d、术后1 d、术后3 d组内的血清SOD、MDA、TNF-α、IL-6、hs-CRP水平比较，差异均具有统计学意义(P<0.05)；在术后1 d、3 d时，观察组血清 SOD均明显高于对照组，血清MDA、TNF-α、IL-6、hs-CRP均明显低于对照组，差异均有统计学意义(P<0.05)；观察组患者的切口、尿路、肺部感染及肠瘘总发生率为4.26%，明显低于对照组的17.02%，差异有统计学意义(P<0.05)。结论 与开腹手术相比，腹腔镜手术具有创伤小、并发症少、术后恢复快等优势，对黏连性肠梗阻患者术后应激、炎症指标影响更轻，其临床应用价值更高。
      【关键词】 黏连性肠梗阻；腹腔镜；应激指标；炎症指标；并发症
      【中图分类号】 R656 【文献标识码】 A 【文章编号】 1003—6350（2019）11—1391—04

Effect of laparoscopic surgery on stress and inflammatory markers in patients with adhesive intestinalobstruction.
ZHU Hong-sheng, XU Liang. Department of General Surgery, Chenggu County Hospital, Chenggu 723200,Shaanxi, CHINA
【Abstract】 Objective To study the effect of laparoscopic surgery on stress and inflammatory markers in pa-tients with adhesive intestinal obstruction. Methods The clinical data of 94 patients with adhesive intestinal obstruc-tion admitted to General Surgery Department, Chenggu County Hospital from January 2017 to July 2018 were retrospec-tively analyzed. According to the different surgical methods, the patients were divided into the observation group and thecontrol group, with 47 cases in each group. The observation group underwent laparoscopic surgery, while the controlgroup underwent laparotomy surgery. The perioperative condition, expression of stress markers (superoxide dismutase[SOD], malondialdehyde [MDA]) and inflammatory markers (tumor necrosis factor-α [TNF-α], interleukin-6 [IL-6],and high sensitive C-reactive protein [hs-CRP]), the incidence of complications were compared between the two groups.Results Compared with the control group, the observation group was significantly shorter in the operation time, inci-sion length, anal exhaust time,out-of-bed activity, and hospitalization time (all P<0.05): (64.93 ± 7.50) min vs (77.81 ±8.14) min; (3.74±0.45) cm vs (15.96±2.77) cm; (21.73±1.88) h vs (35.07±2.59) h; (25.02±1.75) h vs (40.95±2.74) h;(4.29±0.60) d vs (8.83±1.21) d. The observation group was also significantly less in the amount of bleeding during opera-tion: (64.41 ± 7.03) mL vs (116.63 ± 14.87) mL, P<0.05. There were significant differences in the serum SOD, MDA,TNF-α, IL-6 and hs-CRP within groups at before operation1 day, after operation 1 and 3 days (all P<0.05). After opera-tion 1 and 3 days, the serum SOD in the observation group was significantly higher than that in the control group; whileserum MDA, TNF-α, IL-6 and hs-CRP in the observation group were significantly lower than those in the control group(all P<0.05). The incidence of incision, urinary tract, pulmonary infection and intestinal fistula in the observation groupwas 4.26% , which was significantly lower than 17.02% in the control group (P<0.05). Conclusion Compared withopen surgery, the laparoscopic surgery has the advantages of less trauma, fewer complications and faster recovery afteroperation, it has less influence on the post-operative stress and inflammation markers of patients with adhesive intestinalobstruction, which has high clinical application value.
      【Key words】 Adhesive intestinal obstruction; Laparoscopy; Stress markers; Inflammation markers; Complication