腹腔镜下阑尾切除术对急性穿孔性阑尾炎患者氧化应激及炎性反应的影响

Effect of laparoscopic appendectomy on oxidative stress and inflammatory response in patients with acute perforated appendicitis

目的探讨腹腔镜下阑尾切除术对急性穿孔性阑尾炎患者氧化应激及炎性反应的影响。方法选取2013年2月～2018年3月辽阳市中心医院收治的急性穿孔性阑尾炎患者97例为研究对象。按照随机数表法将患者分为对照组(开腹阑尾切除术,48例)和研究组(腹腔镜下阑尾切除术,49例)。比较两组患者术后临床指标,术前、术后1 d氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)]、炎性细胞因子[白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)],并观察两组术后并发症情况。结果研究组术中出血量、手术花费时间、肛门排气时间、术后体温恢复正常时间、住院时间均低于对照组,差异有统计学意义(P <0.05)。术后1 d,两组SOD较术前降低,且对照组低于研究组(P <0.05);术后1 d,两组MDA较术前升高,且对照组高于研究组(P <0.05)。两组IL-6、CRP、TNF-α术后1 d均较术前升高,研究组上述指标水平低于对照组(P <0.05)。研究组术后并发症发生率为10.20%,显著低于对照组的35.42%,差异有统计学意义(P <0.05)。结论腹腔镜下阑尾切除术治疗急性穿孔性阑尾炎患者,可显著改善术后临床指标,减轻患者氧化应激与炎性反应,且能降低术后并发症发生率。

Objective To investigate the effect of laparoscopic appendectomy on oxidative stress and inflammatory response in patients with acute perforated appendicitis. Methods A total of 97 patients with acute perforated appendicitis admitted to Liaoyang Central Hospital from February 2013 to March 2018 were selected. According to random number table method, the patients were divided into control group （open appendectomy, 48 cases） and study group （laparoscopic appendectomy, 49 cases）. Clinical indices in the two groups after operation were compared, as well as levels of oxidative stress index [superoxide dismutase （SOD）, malondialdehyde （MDA）], levels of inflammatory cytokines [interleukin-6 （IL-6）, C reactive protein （CRP）, tumor necrosis factor-α （TNF-α）] before and 1 day after operation. At the same time, the complications of the two groups were observed. Results The amount of bleeding, the time of operation, the time of anus exhaust, the time of body temperature recovery and the time of hospitalization in the study group were all lower than those in the control group, the differences were statistically significant between the two groups （P 〈 0.05）. One day after operation, SOD in the two groups were lower than those before operation, and SOD in the control group was lower than that in the study group （P 〈 0.05）. One day after operation, MDA in the two groups were higher than those before operation, and MDA in the control group was higher than that in the study group （P 〈 0.05）. The levels of IL-6, CRP and TNF-α in the two groups were higher at 1 d after operation than those before operation, but these indices in the study group were lower than those in the control group （P 〈 0.05）. The incidence of complications after operation in the study group was 10.20%, which was significantly lower than that in the control group （35.42%）, and the difference was statistically significant （P 〈 0.05）. Conclusion Laparoscopic appendectomy for acute perforated appendicitis can significantly improve the clinical indices, decrease the oxidative stress and inflammatory response, and reduce the incidence of complications after operation.