不同的胃十二指肠溃疡穿孔修补术对胃蛋白酶原、胃泌素、炎性因子的影响

Effects of different perforation repair for gastric duodenal ulcer on pepsinogen, gastrin and inflammatory factors

目的探讨不同的胃十二指肠溃疡穿孔修补术对胃蛋白酶原(PG)、胃泌素(GS)、炎性因子的影响。方法将符合标准的胃十二指肠溃疡穿孔患者103例,随机分为两组,对照组51例,观察组52例。在常规治疗的基础上,对照组采用开腹修补术,观察组采用腹腔镜下穿孔修补术。术前、术后7天抽外周静脉血检测血清胃蛋白酶原I(PG-I)、胃蛋白酶原Ⅱ(PG-Ⅱ)、胃泌素-17(GS-17),采用酶联免疫吸附双抗夹心检测白介素-2(IL-2)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、C反应蛋白水平变化(CRP)。应用SPSS16.0软件,所获数据采用t检验和2检验。结果两组手术时间、术中出血量、下床时间、肠蠕动时间、住院时间比较,P均<0.0005。两组术前、术后7天血清PG-I、PG-Ⅱ及GS-17水平变化比较,P均>0.05;对照组术前、术后7天血清PG-I、PG-Ⅱ及GS-17水平变化比较,P均>0.05;观察组术前、术后7天血清PG-I、PG-Ⅱ及GS-17水平变化比较,P均>0.05。两组术前IL-2、IL-6、IL-8、TNF-α及CRP水平变化比较,P均>0.05;对照组术前、术后7天IL-2水平变化比较,P>0.05;对照组术前、术后7天IL-6、IL-8、TNF-α及CRP水平变化比较,P均<0.05;观察组术前、术后7天IL-2、IL-6、IL-8、TNF-α及CRP水平变化比较,P均<0.05;两组术后7天IL-2水平变化比较,P>0.05;两组术后7天IL-6、IL-8、TNF-α及CRP水平变化比较,P均<0.05。结论腹腔镜下修补胃十二指肠溃疡穿孔比传统开腹对身体创伤小、应激反应轻,炎性反应弱;两种手术对血清PG-I、PG-Ⅱ及GS-17水平影响均不大。

Objective To investigate the effect of gastroduodenal ulcer perforation repair on pepsinogen（PG）, gastrin（GS） and inflammatory factors. Methods 103 patients with perforating gastroduodenal ulcers were randomly divided into two groups, 51 cases in the control group and 52 in the observation group. On the basis of conventional treatment, the control group received laparotomy and the observation group received laparoscopic perforation repair. Serum PG-I, PG-II,and Gastrin-17（GS-17） were detected at preoperative time and 7 days after operation. IL-2, IL-6, IL-8, TNF-α, CRP levels were tested by enzyme-linked immuno sorbent assay. Using SPSS16.0 software, the data obtained was tested by t test and X^2 test. Results The operative time, intraoperative blood loss, getting off bed time, bowel movement time and hospitalization time of preoperative time and 7 days after operation were compared between the two groups with all P〈0.0005.The changes of serum PG-I, PG-II, and GS-17 levels before surgery and 7 days after the surgery between the two groups were compared with P〉0.05. In the control group, changes of serum PG-I, PG-II, and GS-17 levels before surgery and 7 days after the surgery were compared with P〉0.05. In the observation group, the comparison of those were also with P〉0.05. The changes of IL-2, IL-6, IL-8, TNF-α and CRP levels before operation between the two groups were compared with all P〉0.05. In the control group, the change of IL-2 level before and 7 days after surgery was compared with P〉0.05,but the levels of IL-6, IL-8, TNF-α and CRP were compared with all 〈P0.05. In the observation group, the comparison of IL-2、IL-6、IL-8、TNF-α and CRP before and 7 days after surgery were with all P〉0.05. The change of IL-2 level 7 days after surgery between the two groups was compared with P〉0.05, but the levels of IL-6, IL-8, TNF-α and CRP were compared with all P〈0.05. Conclusion Laparoscopic repair of gastroduodenal ulcer is less traumatic to the body, mild stress reaction and weak inflammatory response than conventional open surgery. The two surgery had no obvious effect on serum PG-I, PG-II and GS-17 levels.