内镜下逆行阑尾炎术治疗急性阑尾炎患儿的效果观察及对免疫功能和炎症因子水平的影响

Observation of endoscopic retrograde appendicitis therapy of acute appendicitis and related effects on immune function and inflammatory factors

目的探讨内镜下逆行阑尾炎治疗术(ERAT)与传统开腹阑尾切除术(OA)治疗急性阑尾炎患儿的效果对比及对免疫功能、炎症因子水平的影响。方法选择2014年2月至2019年6月沈阳急救中心收治的162例急性阑尾炎患儿,随机分成试验组和对照组,各81例。对照组患儿行传统开腹阑尾切除术,试验组患儿行内镜下逆行阑尾炎治疗术。记录2组患儿围手术期指标、炎症因子、免疫功能及并发症,同时2组患儿术后均随访6个月,随访内容以腹痛情况、再就诊及再住院等情况为主。结果试验组患儿手术时间、术后体温恢复正常时间、白细胞恢复正常时间、卧床时间及术后胃肠道功能恢复时间等明显低于对照组(P<0.05)。2组患儿术前1 d和术后7 d炎症因子指标差异无统计学意义(P>0.05);2组患儿术后1 d发现血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和白细胞介素8(IL-8)水平均明显升高,且试验组患儿血清TNF-α、IL-6和IL-8水平明显低于对照组(P<0.05)。2组患儿术前1 d和术后7 d免疫功能指标差异无统计学意义(P>0.05);术后1 d可见2组患儿血清免疫功能明显降低,且试验组患儿免疫功能明显高于对照组(P<0.05)。试验组患儿并发症总发生率为4.94%(4/81),低于对照组的7.41%(6/81),差异无统计学意义(χ^(2)=0.426,P=0.514)。结论 ERAT术可在保留免疫功能和降低炎症反应的基础上提高手术临床疗效,安全有效,值得临床进一步研究并推广。

Objective To compare the effects of endoscopic retrograde appendicitis therapy(ERAT)and open appendectomy(OA)in the treatment of acute appendicitis and explore their impacts on immune function and inflammatory factors.Methods A total of 162 child patients with acute appendicitis treated in the hospital from February 2014 to June 2019 were enrolled as study subjects and were randomly and equally divided into the experimental group(n=81)and the control group(n=81).The control group underwent traditional OA,while the experimental group was treated with ERAT.Data concerning perioperative period,inflammatory factor,immune function and complications were recorded and compared between the 2 groups.After surgery,the patients in the 2 groups all had a 6-month medical follow-up,focusing on abdominal pain,return visit and re-hospitalization.Results The surgical time,postoperative body temperature recovery time,leukocyte recovery time,bed rest time and postoperative gastrointestinal function recovery time in the experimental group were significantly lower than those in the control group(P<0.05).There were no significant differences in the indexes of inflammatory factors 1 day before surgery and 7 days after surgery,when comparisons were made between the 2 groups(P>0.05).One day after treatment,the levels of serum tumor necrosis factor(TNF-α),interleukin 6(IL-6)and interleukin 8(IL-8)in the 2 groups all increased significantly,and the levels of TNF-α,IL-6 and IL-8 in the experimental group were significantly lower than those in the control group(P<0.05).There was no statistical significance in immune function between the two groups 1 day before surgery and 7 days after surgery,when comparisons were made between the 2 groups(P>0.05).However,1 day after treatment,the immune function of the 2 groups decreased significantly,with the immune function of the experimental group being significantly higher than that of the control group(P<0.05).The total rate of complications in the experimental group(4.94%)was lower than that in the control group(7.41%),with statistical significance(χ^(2)=0.426,P=0.514).Conclusion ERAT could improve the clinical efficacy of surgery in addition to preserving immune function and reducing inflammatory reaction,and is clinically safe and effective.For this reason,it is worth further clinical promotion.