标题：小肠内排列术与开腹黏连松解术对广泛黏连性肠梗阻患者的疗效及 IL-4、TNF-α的影响

      作者：王彤彤，解基良    (天津市中西医结合南开医院胃肠外科，天津 300100)

      卷次： 2017年28卷22期

      【摘要】 目的 研究小肠内排列术与开腹黏连松解术对广泛黏连性肠梗阻患者的疗效及白细胞介素-4(IL-4)、肿瘤坏死因子-α (TNF-α)的影响。方法 选取2013年1月至2014年3月在天津市中西医结合南开医院胃肠外科接受治疗的广泛黏连性肠梗阻患者86例，根据随机数表法分为观察组与对照组各43例。对照组患者给予开腹黏连松解术治疗，观察组患者则给予小肠内排列术治疗。比较两组患者的手术时间、术中出血量、肠管损伤、术后通气时间、住院时间、住院费用，血清 IL-4与TNF-α水平以及并发症发生率。所有患者均进行为期 3年的随访。结果 观察组患者的手术时间为(155.2±2.0) min，明显高于对照组的(118.3±1.4) min，差异有统计学意义(P<0.05)；观察组患者术后通气时间、住院时间、住院费用均明显低于对照组，差异均有统计学意义(P<0.05)；治疗后，观察组患者的血清 IL-4水平明显高于对照组，而TNF-α水平则明显低于对照组，差异均有统计学意义(P<0.05)；治疗后，观察组患者的感染、肠瘘、再次肠梗阻的发生率分别为 2.33%、0、2.33%，明显低于对照组的 15.28%、11.03%、20.93%，差异均有统计学意义(P<0.05)。随访结果显示：观察组患者不完全肠梗阻症状发生率为0 (0/43),对照组不完全肠梗阻症状发生率为4.65% (2/43)，两组比较差异无统计学意义(P>0.05)。结论 小肠内排列术治疗广泛黏连性肠梗阻的疗效显著，可有效促进患者早日康复，不会对患者造成严重的炎症反应，降低并发症发生率。
      【关键词】 广泛黏连性肠梗阻；小肠内排列术；疗效；炎症因子
      【中图分类号】 R656.7 【文献标识码】 A 【文章编号】 1003—6350（2017）22—3651—03

Effect of intestinal arrangement and open lysis of adhesions on the efficacy and IL-4, TNF-alpha in patients withextensive adhesive intestinal obstruction.
WANG Tong-tong, JIE Ji-liang. Department of Gastrointestinal Surgery,Nankai Hospital, Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin 300100, CHINA
【Abstract】 Objective To study the effect of small bowel arrangement and open lysis of adhesions on the effica-cy and the levels of interleukin-4 (IL-4) and tumor necrosis factor-α (TNF-α) in patients with extensive adhesive intesti-nal obstruction. Methods From January 2013 to March 2014, a total of 86 cases of patients with extensive adhesive in-testinal obstruction, who admitted to Department of Gastrointestinal Surgery of Nankai Hospital of Integrated TraditionalChinese and Western Medicine of Tianjin and underwent gastrointestinal surgery treatment, were selected and divided in-to the observation group and the control group according to random number table, with 43 cases in each group. The con-trol group was treated with abdominal adhesions treatment, and the observation group was given surgical treatment ofsmall intestinal arrangement. The operation time, intraoperative blood loss, intraoperative intestinal injury, postoperativeventilation time, hospitalization time and hospitalization costs, the levels of serum IL-4 and TNF-α level, and the inci-dence of complications were compared between the two groups. All patients were followed up for 3 years. Results Theoperation time of the observation group was (155.2±2.0) min, which was significantly higher than (118.3±1.4) min of thecontrol group (P<0.05). The postoperative ventilation time, hospitalization time and hospitalization costs of the observa-tion group were significantly lower than those of the control group (P<0.05). After the treatment, the serum IL-4 level in·论 著·doi:10.3969/j.issn.1003-6350.2017.22.012基金项目：天津市卫计委攻关课题(编号：14KG131)