腹腔镜阑尾切除术对阑尾炎患者血清炎性因子和胃肠功能的影响

Effect of laparoscopic appendectomy on serum inflammatory factors and gastrointestinal function for patients with appendicitis

目的探讨腹腔镜阑尾切除术对阑尾炎患者血清炎性因子和胃肠功能的影响。方法选取2015年1月至2017年3月于本院接受阑尾切除术治疗的155例阑尾炎患者,根据手术是否引入腹腔镜分为观察组(85例)与对照组(70例),观察组患者接受腹腔镜阑尾切除术治疗,对照组患者接受开腹阑尾切除术治疗,分析两组患者手术前后血清炎性因子水平和术后胃肠功能恢复指标。结果两组患者术前血清α-肿瘤坏死因子(TNF-α)(t=0.171、P=0.865)、C-反应蛋白(CRP)(t=0.556、P=0.579)和淀粉样蛋白A(SAA)(t=0.317、P=0.752)差异无统计学意义。手术后,观察组患者血清TNF-α(t=2.634、P=0.009)、CRP(t=6.140、P<0.001)和SAA(t=2.160、P=0.032)显著低于对照组,差异均具有统计学意义。观察组患者手术时间显著长于对照组(t=6.703、P<0.001),术中出血量(t=14.168、P<0.001)、术后肠鸣音恢复时间(t=3.859、P<0.001)、术后肛门排气时间(t=3.374,P=0.001)、术后肛门排便时间(t=2.994、P=0.003)和术后住院时间(t=6.917、P<0.001)均显著低于对照组,差异有统计学意义。结论与开腹阑尾切除术相比,阑尾炎患者腹腔镜阑尾切除术后血清炎性因子水平下降更显著,胃肠功能恢复更快。

Objective To investigate the effect of laparoscopic appendectomy on serum inflammatory factors and gastrointestinal function for patients with appendicitis. Methods Total of 155 patients with appendicitis underwent appendectomy who were selected in our hospital from January 2015 to March 2017 and were divided into the observation group（85 cases） and control group（70 cases） according to whether with laparoscopic surgery. The patients in observation group underwent laparoscopic appendectomy, and patients in the control group received open appendectomy. The levels of serum inflammatory factors and postoperative gastrointestinal function recovery indexes were analyzed before and after surgery in both groups, respectively. Results Preoperative serum levels of α-tumor necrosis factor（TNF-α）（t = 0.171, P = 0.865）, C-reactive protein（CRP）（t = 0.556, P = 0.579）, and amyloid A（SAA）（t = 0.317, P = 0.752） were not significantly different between the two groups. After operation, the serum levels of TNF-α（t = 2.604, P = 0.010）, CRP（t = 6.061, P〈0.001） and SAA（t = 2.134, P = 0.034） in the observation group were significantly lower than those of the control group, with significant differences. The operation time of the patients in observation group was significantly longer than that of the control group（t = 6.703, P〈0.001）, and the amount of bleeding（t = 14.168, P〈0.001）, postoperative recovery time of bowel sounds（t = 3.859, P〈0.001）, postoperative anal exhaust time（t = 3.374, P = 0.001）, defecation time after operation（t = 2.994, P = 0.003） and postoperative hospitalization time（t = 6.917, P〈0.001） were significantly lower than those of the control group, with significant differences. Conclusions Compared with open appendectomy, laparoscopic appendectomy could effectively reduce postoperative inflammatory factors and promote gastrointestinal function recovery.