腹腔镜胆囊切除术的患者术后急性创伤反应的研究

Research of the systemic inflammatory response syndiomes after the laparoscopic gallbladder

目的比较腹腔镜与开腹胆囊切除术对机体急性炎症应激(SIRS)反应的影响。方法将2007年3月至2009年10月间我院130例行胆囊切除术患者随机纳入腹腔镜胆囊手术组(70例)及开腹对照组(60例),所有手术均由同一手术小组固定成员实施。比较两组患者手术前后白细胞总数、中性粒细胞百分数的变化以及CRP急性期蛋白的改变,同时比较两组患者术后7d期间SIRS发生的情况。结果两组间术后白细胞总数(WBC)及中胜粒细胞百分数(NE%)比较无统计学差异(P>0.05)。术后1、3、5d开腹组CRP表达更高(P<0.05)。术后1、5d开腹组的SIRS发生率高于腹腔镜组,而且术后1～7d期间开腹组患者发生SIRS持续时间高于腹腔镜组(P<0.05)。结论腹腔镜组术后CRP急性蛋白表达都较开腹组低,提示腹腔镜组术后炎症应激更轻。腹腔镜胆囊组手术造成机体的氧化应激反应虽然较开腹组明显,但术后消退也较开腹组快,未对机体产生明显不良影响。

Objective To investigate the influence of the laparoseopic and open gallbladder on the in- flammatory stress and oxidative stress. Methods There were 130cases done gallbladder during March,2007 to October ,2009, in which 70cases were prospectively into the laparoseopic group, while other 60 cases were in the open group, all the operations were done by the same surgeon group. Compare the change of the WBC, NE% CRP and the SIRS frequency during 7 days after operation. Results There were no statistical difference of the WBC and NE% level between two groups （ P 〉 0. 05 ）. Acute phase proteins such as CRP were higher in the open group than that in the laparoseopic group on the 1,3, 5 days after the operation （ P 〈 0. 05 ）, while the protective protein was higher in the laparoscopic group than that in the open group on the 1 st, 3rd days postoperation（ P 〈 0. 05 ）. The incidence rate of SIRS was higher on the lt, 5 days postoperatively, furthermore, the duration of the postoperative SIRS was also higher in the open group （ P 〈 0. 05 ）. Conclusions The level of the acute phase protein as CRP were lower in the laparoseopic group indicates that the laparoscopic gallbladder was a less inflammatory stress. Though the oxidative stress level was higher in the laparoseopic group, the regression was also faster than that of in the open and it will not develop consistant harmful effect.