手助腹腔镜与开腹改良Sugiura术对围术期机体神经内分泌反应的前瞻性对照研究

Effects of Hand-assisted Laparoscopy vs.Modified Open Sugiura Procedure on Perioperative Neuroendocrine Stress Response: A Prospective Controlled Study

目的探讨手助腹腔镜与开腹改良Sugiura术对机体神经内分泌反应的影响。方法 2011年1月～2012年3月,将我科需要行改良Sugiura术的56例门静脉高压症按医生手术习惯和患者意愿分为手助腹腔镜组和开腹组,每组28例。于术前1 d,手术开始1 h,术后即刻,术后1、2、4 d抽取静脉血,检测肾上腺素(E)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)水平,并进行双因素重复测量资料方差分析。结果 2组患者E、NE、ACTH、Cor比较F值分别为7.592、15.612、87.821、34.513,P值均<0.05;组内不同时间点比较F值分别为867.084、979.812、2189.563、1897.142,P值均=0.000;组别-时间F值分别为39.471,75.556、54.472、297.623,P值均=0.000,表明4个指标2组间存在显著差异,不同时间点不全相同,在不同时间点的变化趋势也不全相同。结论手助腹腔镜改良Sugiura术较开腹改良Sugiura术对机体神经内分泌反应影响小,有利于患者的恢复。

Objective To compare prospectively the effects of hand-assisted laparoscopy（HALS） on neuroendocrine stress response in patients with portal hypertension with that of modified open Sugiura procedure.Methods From January 2011 to March 2012,we divided 56 patients with portal hypertension into HALS and open groups with 28 in each according to doctors’ habits and patients’ wishes.We collected venous blood sample one day before the operation,immediately after the operation,and 1,2,and 4 days after the operation to determine the level of epinephrine（E）,norepinephrine（NE）,adrenocorticotropic hormone（ACTH） and cortisol（Cor） which were then analyzed by the ANOVA of two-factor repeated measures.Results The F value of E,NE,ACTH and Cor between the two groups was 7.592,15.612,87.821,and 34.513,respectively（all P＆lt;0.05）.The F value of E,NE,ACTH and Cor within groups（time） was 867.084,979.812,2189.563,and 1897.142（all P=0.000）.And the F value of E,NE,ACTH and Cor between groups-within groups（time） was 39.471,75.556,54.472,and 297.623（all P=0.000）.The statistics indicated that there existed significant difference in the four indicators between the groups and among different time points,and in the trends among different time points.Conclusion HALS has less effect than modified open Sugiura procedure on neuroendocrine stress response in patients with portal hypertension,and thus is better for postoperative recovery.