腹腔镜下小儿疝高位结扎术治疗小儿疝气的效果及对炎症因子和肠黏膜屏障功能的影响

Effect of Laparoscopic High Ligation of Hernia in Children and its Effect on Inflammatory Factors and Intestinal Mucosal Barrier Function

【目的】探讨腹腔镜下小儿疝高位结扎术治疗小儿疝气的临床效果及对炎症因子和肠黏膜屏障功能的影响。【方法】选取2018年10月至2020年10月本院收治的140例疝气患儿,采用随机数表法将其分为对照组(传统手术治疗)和观察组(腹腔镜下小儿病高位结扎术治疗),各70例。记录两组手术时间、切口长度、术中出血量、首次肛门排气时间和住院时间,比较两组术前24 h和术后8 h、24 h疼痛评分,分析两组术前24 h及术后24 h血清C反应蛋白(CRP)、白介素-10(IL-10)、白介素-β(IL-1β)水平和尿乳果糖/甘露醇(L/M)比值、尿肠形脂肪酸结合蛋白(IFABP)水平,并观察两组术前24 h及术后24 h血D-乳酸(I>LA)水平。【结果】观察组手术时间、切口大小、术中出血量、首次肛门排气时间和住院时间均低于对照组(P<0.05)。术后8 h、24 h,两组疼痛评分均较术前24 h明显降低,且观察组均低于对照组,差异有统计学意义(P<0.05)。术后24 h,两组血清CRP、IL-10、IL-1β水平均高于术前24 h,且观察组低于对照组(P<0.05)。术后24 h,对照组血清D-LA及尿L/M、IFABP水平高于术前24 h(P<0.05),观察组较术前24 h无统计学差异(P>0.05),且观察组低于对照组(P<0.05)。【结论】相对于传统手术,腹腔镜下小儿疝高位结扎术治疗小儿疝气临床疗效更好,能明显减少术中出血量,缩短手术时间、肛门排气时间和住院时间,并且炎症应激反应较轻,对肠黏膜屏障功能的影响较小。

【Objective】To investigate the clinical effect of laparoscopic high ligation of pediatric hernia and its effect on inflammatory factors and intestinal mucosal barrier function.【Methods】A total of 140 children with hernia treated in our hospital were randomly divided into control group(traditional surgical treatment)and observation group(laparoscopic high ligation of childrens hernia),with 70 cases in each group.The operation time,incision length,intraoperative bleeding,first anal exhaust time and hospital stay were recorded.The pain scores 24 hours before operation and 8 and 24 hours after operation were compared between the two groups.The serum C-reactive protein(CRP),interleukin-10(IL-10)and interleukin-1 were analyzed 24 hours before operation and 24 hours after operation β(IL-1β)And urinary lactulose/mannitol(L/M)ratio,urinary intestinal fatty acid binding protein(iFABP),and the levels of blood D-lactic acid(D-LA)24 hours before and 24 hours after operation were observed.【Results】The operation time,incision size,intraoperative bleeding,first anal exhaust time and hospital stay in the observation group were lower than those in the control group(P<0.05).At 8 h and 24 h after operation,the pain scores of the two groups were significantly lower than that of the control group,and the difference was statistically significant(P<0.05).24 hours after operation,the levels of serum CRP,IL-10 and IL-1β in the two groups in the observation group were lower than those in the control group(P<0.05).At 24 hours after operation,the levels of serum D-LA,urinary L/M and IFABP in the control group were higher than those at 24 hours before operation(P<0.05),there was no significant difference in the observation group(P>0.05),and the levels in the observation group were lower than those in the control group(P<0.05).【Conclusion】Compared with traditional surgery,laparoscopic high ligation of pediatric hernia has better clinical effect in the treatment of pediatric hernia.It can significantly reduce the amount of intraoperative bleeding,shorten the operation time,anal exhaust time and hospital stay,and has less inflammatory stress response and less impact on the function of intestinal mucosal barrier.