腹腔镜手术治疗小儿急性化脓性阑尾炎术后免疫、炎症水平观察

Postoperative immune and inflammatory responses after laparoscopic surgery in children with acute suppurative appendicitis

目的观察腹腔镜手术治疗小儿急性化脓性阑尾炎后免疫、炎症水平的变化。方法选择105例急性化脓性阑尾炎患儿,分为观察组56例与对照组49例。对照组患儿采取开腹阑尾切除术,观察组患儿采取腹腔镜阑尾切除术。比较2组患儿的手术时间、术中出血量、术后排气时间、下床活动时间、抗菌药物应用时间、住院时间,对比2组患儿术前和术后1周的淋巴细胞、中性粒细胞、白细胞计数的变化,以及术前和术后1 d的血清IL-6、IL-8、CRP的变化,观察2组术后并发症的发生情况。结果与对照组相比,观察组患儿的术中出血量较少、术后排气及下床活动较早、抗菌药物应用时间及住院时间较短(P均<0. 05)。术后1周,2组患儿的淋巴细胞、中性粒细胞、白细胞均较术前减少(P均<0. 05);观察组患儿的淋巴细胞、中性粒细胞、白细胞少于对照组(P均<0. 05)。术后1 d,2组患儿的血清IL-6、IL-8与CRP水平均较术前升高(P均<0. 05);观察组患儿的血清IL-6、IL-8与CRP水平均低于对照组(P均<0. 05)。观察组患儿的并发症总发生率低于对照组(P <0. 05)。结论腹腔镜手术治疗小儿化脓性阑尾炎创伤小,患儿术后恢复快,且术后免疫及应激反应比开腹手术轻,并发症少。

Objective To observe the changes of immune and inflammatory responses after laparoscopic surgery in children with acute suppurative appendicitis. Methods A total of 105 children diagnosed with acute suppurative appendicitis were selected andassigned into the observation （n=56） and control groups （n=49）. In the control group, childrenunderwent open appendectomy, and those in the observation group received laparoscopic appendectomy. The operative time, intraoperative blood loss, postoperative exhaust time, ambulation time, time of antibiotic drug use andlength of hospital stay were statistically compared between two groups.The levels of lymphocyte count （LY）, neutrophil count （NEUT）, white blood cell count （WBC） before and one week after operation and the serum levels of interleukin 6 （IL-6）, interleukin 8 （IL-8）, C-reactive protein （CRP） before operation and 1d after operation were compared between two groups.The incidence of postoperative complications was observed in two groups. Results Compared with the control group, the intraoperative blood loss was significantly less, postoperative exhaust time, ambulation time, time of antibiotic drug use and length of hospital stay were considerably shorter in the observation group （all P 〈 0.05）. The levels of LY, NEUT and WBCat 1 d after operation were significantly lower than preoperative levels in both groups（all P 〈 0.05）. The serum levels of IL-6, IL-8 and CRP at postoperative 1 d were dramatically higher than preoperative levels in both groups （all P 〈 0.05）. The serum levels of IL-6, IL-8 and CRP in the observation group were significantly lower compared with those in the control group（all P 〈 0.05）. The incidence of postoperative complications in the observation group was considerably lower than that in the control group （P 〈 0.05）. Conclusion Laparoscopic surgery yields mild surgical trauma, accelerates postoperative recovery, induces less immune and stress responses and causes fewer postoperative complications than open surgery in children with acute suppurative appendicitis.