腹腔镜胃十二指肠溃疡穿孔修补术与传统开腹手术的疗效及细胞免疫功能的影响比较

The Comparison of Laparoscopic Gastroduodenal Ulcer Perforation Repair Surgery and Traditional Open Surgery's Efficacy and Affect on Immune Function

目的:观察比较腹腔镜胃十二指肠溃疡穿孔修补术与传统开腹手术的临床疗效以及细胞免疫功能的影响。方法:随机选择2015年1-12月本院进行胃十二指肠穿孔治疗患者60例,根据来诊时间序列号单号为观察组,双号为对照组,每组各30例。观察组患者行腹腔镜胃十二指肠溃疡穿孔修补术,对照组患者行开腹手术。观察两组患者手术时间、术中出血量、肠蠕动恢复时间、住院时间、感染、肠粘连等术后并发症情况以及CD3^+、CD4^+、C反应蛋白(CRP)在术前、术后第1、3、5天的变化。结果:观察组患者手术时间明显长于对照组,但是术中出血量、肠蠕动恢复时间、住院时间以及并发症发生情况均明显少于对照组,两组比较差异均有统计学意义(P<0.05)。两组患者CD3^+、CD4^+手术前后比较差异均无统计学意义(P>0.05),但是观察组术后1、7 d明显高于对照组,两组比较差异均有统计学意义(P<0.05)。两组患者术后CRP均有所升高,但对照组升高的更为明显,两组比较差异有统计学意义(P<0.05)。结论:腹腔镜十二指肠溃疡穿孔修补术的临床疗效优于传统开腹手术,且其对患者细胞免疫功能的影响则明显更低,值得临床推广应用。

Objective：To explore the efficacy of laparoscopic gastric ulcer perforation repair and traditional open surgery and the affect on cellular immune function.Method：60 cases of gastric and duodenal perforation patients were selected in our hospital from January to December 2015,they were divided into observation group of single number and control group of double number according to the visiting time,30 cases in each group.Observation group underwent laparoscopic gastric ulcer perforation repair,the control group underwent laparotomy.Surgery time,blood loss,bowel recovery time,postoperative hospital stay,infection,adhesions and other complications of two groups were observed and compared,the change of CD3^＋,CD4^＋,C-reactive protein（CRP） in the preoperative time and postoperative after 1,3,5 d of two groups were observed.Result：Operative time of observation group was significantly longer than the control group,but the amount of blood loss,bowel recovery time,hospital stay and complications were significantly less than the control group,the differences were statistically significant（P〈0.05）.The two groups＇ CD3^＋ and CD4^＋ number had no significant difference before and after surgery（P〉0.05）,but at 1 and 7 d after surgery,the observation group were significantly higher than control group,the differences were statistically significant（P〈0.05）.The postoperative CRP of two groups were increased,but the control group increased more significantly,the difference was statistically significant（P〈0.05）.Conclusion：The clinical efficacy of laparoscopic duodenal ulcer perforation repair surgery is better than traditional open surgery,its impact on patients＇ cellular immune function is significantly lower,and should be promoted in clinical application.