手助腹腔镜与开腹巨脾切除术对机体应激反应的影响

Effects of hand-assisted laparoscopic splenectomy and open splenectomy for giant spleens on systemic stress responses

目的:总结手助腹腔镜与开腹巨脾切除术对患者术后机体应激反应的影响。方法:随机选取2006年8月至2011年10月40例巨脾患者,根据其经济状况及意愿分为两组,每组20例,分别行手助腹腔镜脾切除术(hand-assisted laparo-scopic splenectomy,HALS)及传统开腹脾切除术(open splenectomy,OS),对比分析两组患者术前、术后皮质醇(cortisol,COR)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、C-反应蛋白(C-reactive protein,CRP)水平。结果:术后1天HALS组COR、TNF-α、IL-6、CRP水平均低于OS组(P<0.05),术后3天TNF-α、CRP水平低于OS组(P<0.05),术后5天CRP低于OS组(P<0.01)。结论:相对开腹手术而言,手助腹腔镜巨脾切除术对患者术后机体应激反应的影响较小,充分显示了其微创的优越性。

Objective：To summarize the influences of hand-assisted laparoscopic splenectomy and open splenectomy for giant spleens on systemic stress response. Methods：Forty patients diagnosed as giant spleens from Aug. 2006 to Oct. 2011 were divided into two groups according to their economic status and will,20 cases were operated by hand-assisted laparoscopie splenectomy（HALS） ,and the other 20 cases were operated by open splenectomy （OS）. Plasma levels of cortiso]（COR） ,tumor necrosis faetor-o^（TNF-c^） ,inter- leukin-6（lL-6） and C-reactive protein（CRP） were measured before and after surgery and comparatively analyzed. Results：The mean value of laboratory test of HALS group was significantly less than that of OS group in such indexes as plasma levels of COR, TNF-a, IL- 6 and CRP on the 1st day after operation （P 〈0.05） ,TNF-α and CRP on the 3rd day after operation （P 〈0.05） ,CRP on the 5th clay after operation. （P 〈 0.01 ）. Conclusions：Compared with open splenectomy, hand-assisted laparoscopie spleneetomy for giant spleens has the advantages of less systemic stress response and more minimal invasiveness.