腹腔镜与开腹手术治疗轻中度粘连性肠梗阻对前白蛋白及炎症因子水平的影响

Effects of Laparoscopic and Open Surgery on the Levels of Prealbumin and Inflammatory Factors in the Treatment of Mild to Moderate Adhesive Intestinal Obstruction

目的:探讨腹腔镜手术与开腹手术治疗轻中度粘连性肠梗阻对患者前白蛋白(PA)及炎症因子水平的影响。方法:将2013年8月至2015年6月于我院确诊为轻中度粘连性肠梗阻并要求行手术治疗的90例患者纳入研究,44例采用传统开腹手术治疗患者为对照组,46例采用腹腔镜手术治疗患者为观察组。比较2组患者治疗前及治疗第7天时白介素-6(IL-6)、肿瘤坏死因子(TNF-α)等炎症因子及PA水平的变化情况,以及手术疗效和术后并发症情况。结果:2组患者均顺利完成手术,观察组住院时间、术中出血量更少,肛门排气时间、下床活动时间、肠鸣音恢复时间均更短,且术后疼痛视觉模拟评分(VAS评分)更低(P<0.05);观察组术后并发症总发生率低于对照组,且远期复发率更低(P<0.05);2组患者治疗后IL-6、TNF-α水平均降低,PA水平则升高,但观察组改善更显著(P<0.05)。结论:腹腔镜手术与开腹手术治疗轻中度粘连性肠梗阻均疗效确切,但前者具有创伤小,可更好地改善机体白蛋白水平,降低炎症反应,且并发症少,值得推广。

Objective： To investigate the effect of laparoscopic and open surgery on the levels of prealbumin （PA） and inflammatory factors in the treatment of mild to moderate adhesive intestinal obstruction. Methods： A total of 90 patients with mild to moderate adhesive intestinal obstruction from Aug 2013 to Jun 2015 required surgical treatment were included in the study. Forty- four patients underwent conventional open surgery as control group and 46 patients underwent laparoscopic surgery as the observation group. IL-6 and tumor necrosis factor （TNF-α） and PA were measured before and at 7 days after treatment, and the curative effect and postoperative complications were analyzed. Results ： The hospitalization time, intraoperative blood loss, exhaust time, time of activities, and recovery time of bowel sounds in the observation group were better than those in the control group. And the postoperative visual analogue scale （VAS） was also significantly lower in the observation group （P〈0.05） . The incidence rate of postoperative complications and long-term recurrence rate in the observation group were lower than those in the control group （P〈 0.05） . The levels of IL-6 and TNF-o~ in the two groups were significantly lower than those before treatment （P〈0.05）, and the level of PA also increased significantly after treatment： Howerer, the levels of IL-6 and TNF-α were markedly lower and the level of PA protein was significantly higher in the observation group （P〈0.05） . Conclusion ： Laparoseopie and open surgery are effective in the treatment of mild to moderate adhesive intestinal obstruction, but the former has the advantages of small trauma, increased PA levels, reduced inflammatory response, and less complications, which is worthy of clinical promotion.