腹腔镜及二氧化碳气腹对腹内感染影响的临床研究

Clinical Study For Effects of Laparoscopy and Carbon Dioxide Pneumoperitoneum on Intraabdominal Infection

目的研究二氧化碳气腹及腹腔镜手术对细菌性腹膜炎的影响。方法31例急性阑尾炎患儿,分为开腹组16例,腹腔镜组15例,于术前、术后采集病人血液行细菌培养,检测血中白细胞及炎症因子水平,并观察切口及腹腔有无残余脓肿情况。结果开腹组较腹腔镜组,术后切口感染及腹腔脓肿发生率高,术后C反应蛋白、肿瘤坏死因子α水平及白细胞总数升高更明显,下降缓慢,淋巴细胞受抑制更明显。结论在细菌性腹膜炎时,腹腔镜气腹手术较开腹手术炎症反应轻,免疫功能恢复快。应用腹腔镜及二氧化碳气腹治疗腹部外科感染性腹部外科疾病安全可靠。

Objective To study the effects of CO2 pneumoperitoneum on bacterial peritonitis during laparoscopy. Methods 31 patients with acute appendicitis,including 16 patients in laparotomy group and 15 patients in laparoscopy group.Before and after surgery,the peripheral blood were obtained for bacterial culture,white blood cells and inflammatory factors levels were measured.After surgery,the incision infections and intraabdominal abscess were checked. Results The incidence of postoperative incision infection and intraabdominal abscess were higher in laparotomy group than in pneumoperitoneum group. The C reactive protein(CRP) and TNF-α levels,white blood cells count in laparotomy group after surgery were significantly higher,however dropping rate was more slowly,at the same time, lymph cells were inhibited more obviously. Conclusions At bacterial peritonitis,the inflammatory response was no serious and the immune function was restored more quickly during laparoscopy than that in laparotomy.The application of laparoscopy and CO2 pneumoperitoneum to treat the infected abdominal surgical diseases is safe and reliable.