腹腔镜治疗创伤性小肠破裂的临床研究

Clinical research of laparoscopic surgery in the treatment of traumatic rupture of small intestine

目的研究腹腔镜治疗创伤性小肠破裂(traumatic rupture of small intestine,TROSI)的临床效果。方法 2013年1月—2016年12月宁夏医科大学总医院收治TROSI患者106例,按照手术方法将患者分为腹腔镜组(n=56)与开腹组(n=50)。开腹组行开腹治疗,腹腔镜组行腹腔镜治疗。观察两组手术指标,术前、术后3d疼痛评分,血清去甲肾上腺素(NE)、K+、五羟色胺(5-HT)等疼痛因子水平,血清肠脂肪酸结合蛋白(IFABP)水平,血清免疫球蛋白A、G(Ig A、Ig G)、CD4+、CD4+/CD8+等免疫因子水平,术后并发症等指标。结果腹腔镜组术中出血量(70.87±7.13)m L、术后肛门排气时间(1.89±0.19)d、术后首次下床时间(3.22±0.33)d、住院时间(6.27±0.65)d,均少于开腹组[术中出血量(198.95±21.06)m L、术后肛门排气时间(3.26±0.33)d、术后首次下床时间(5.84±0.61)d、住院时间(9.54±0.98)d)];腹腔镜组手术时间(164.86±17.65)min,长于开腹组(124.65±13.86)min,差异有统计学意义(P<0.05)。术后3d,腹腔镜组视觉模拟评分(VAS)、血清NE、K+、5-HT均低于开腹组(P<0.05)。术后3d,腹腔镜组Ig A、Ig G、CD4+、CD4+/CD8+均低于开腹组(P<0.05),IFABP与开腹组差异无统计学意义(P>0.05)。腹腔镜组术后并发症发生率(3.57%)低于开腹组(18.00%),差异有统计学意义(P<0.05)。结论腹腔镜治疗TROSI创伤小,疼痛轻,对免疫机制扰动小,术后恢复快,术后并发症发生率低。

Objective To study the clinical effect of laparoscopic surgery in the treatment of traumatic rupture of small intestine （TROSI）. Methods A total of 106 TROSI patients admitted to our hospital from Jan. 2013 to Dec. 2016 were selected,and divided into laparoscope group（ n =56） and laparotomy group（ n =50） according to the operation method. Patients in laparotomy group were performed laparotomy,and those in laparoscope group were performed laparoscopic surgery. The surgical indexes,pain scores at 3 days before and after operation,the levels of pain factors such as serum norepinephrine （NE）,K ＋ and 5-hydroxytryptamine（5-HT）,the level of serum intestinal fatty acid binding protein （IFABP）,the levels of immune factors such as serum immunoglobulin A and immunoglobulin G （IgA,IgG）,CD4 ＋ and CD4 ＋/CD8 ＋ and postoperative complications in the two groups were observed. Results The intraoperative blood loss,postoperative anus exhaust time,postoperative getting out-of-bed time and hospitalization time in laparoscope group were less than those in laparotomy group,and the operation time was longer than that in laparotomy group（ P 〈0.05）. At 3 days after operation,the VAS score and the levels of serum NE,K ＋ and 5-HT in laparoscope group were lower than those in laparotomy group（ P 〈0.05）,and the levels of IgA,IgG,CD4 ＋,CD4 ＋/CD8 ＋ in laparoscope group were lower than those in laparotomy group（ P 〈0.05）. There was no significant difference of IFABP between the two groups（ P 〉0.05）. The incidence of postoperative complications in laparoscope group （3.57%） was lower than that in laparotomy group （18.00%, P 〈 0.05）. Conclusion Laparoscopic surgery in the treatment of TROSI has small trauma,mild pain,small disturbance to the immunologic mechanism,rapid postoperative recovery and low incidence of postoperative complications.