不同手术方法治疗小儿穿孔性阑尾炎的效果及对炎症应激反应和免疫功能的影响

Effects of different surgical methods on children with perforated appendicitis and the influence of inflammatory stress response and immune function

目的:探究腹腔镜阑尾切除术与传统开腹手术治疗小儿穿孔性阑尾炎的效果及对炎症应激反应和免疫功能的影响。方法:选择2017年1月至2020年1月在西南医科大学附属医院进行治疗的穿孔性阑尾炎患儿100例,根据不同手术方式分为对照组52例、观察组48例。对照组采用传统开腹手术进行阑尾切除,观察组采用腹腔镜阑尾切除术。对比2组手术一般情况及术后并发症发生情况,检测并比较2组术前及术后1、3 d的血清炎症因子[白细胞介素-6(interleukin-6,IL-6)、C反应蛋白(C-reaction protein,CRP)]、免疫功能指标[T淋巴细胞亚群(包括CD3^(+)、CD4^(+))]水平。结果:2组手术时间比较差异无统计学意义(P>0.05),观察组术后首次排气时间、体温复常时间及住院时间均短于对照组(P<0.05);观察组术后并发生症总发生率为6.25%,低于对照组的21.15%(P<0.05);与术前相比,2组术后1 d时IL-6、CRP水平均升高(P<0.05),术后3 d时IL-6、CRP水平均降低(均P<0.05),观察组术后1、3 d的血清IL-6、CRP水平均低于对照组(P<0.05);与术前相比,2组术后1、3 d时CD3^(+)、CD4^(+)水平均降低(均P<0.05),观察组术后1、3 d的CD3^(+)、CD4^(+)水平均高于对照组(均P<0.05)。结论:腹腔镜阑尾切除术治疗小儿穿孔性阑尾炎,术后恢复较快且并发症较少,可改善术后炎症应激反应及免疫功能。

Objective:To explore the effect of laparoscopic appendectomy and traditional open surgery on children with perforated appendicitis and the influence of inflammatory stress response and immune function.Methods:A total of 100 children with perforated appendicitis treated in our hospital from January 2017 to January 2020 were selected and divided into a control group(52 cases)and an observation group(48 cases)according to different surgical methods.The control group was treated with traditional open surgery for appendectomy,and the observation group was treated with laparoscopic appendectomy.The general operation conditions and postoperative complications were compared between the 2 groups.The levels of serum inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP)]and immune function indexes[T lymphocyte subsets(including CD3^(+),CD4^(+))]were detected and compared between the 2 groups before the operation and 1 and 3 d after the operation.Results:There was no statistically significant difference in operation time between the 2 groups(P>0.05).The first exhaust time,body temperature recovery time and hospitalization time in the observation group were shorter than those in the control group(all P<0.05).The total incidence of postoperative complications in the observation group was 6.25%,which was lower than 21.15%in the control group(P<0.05).Compared with before the operation,the levels of IL-6 and CRP in the 2 groups increased at 1 d after the operation(all P<0.05),and decreased at 3 d after the operation(P<0.05);the levels of serum IL-6 and CRP in the observation group were lower than those in the control group at 1 and 3 d after the operation(all P<0.05).Compared with before the operation,the levels of CD3^(+) and CD4^(+) in the 2 groups were decreased at 1 and 3 d after the operation(all P<0.05),and the levels of CD3^(+) and CD4^(+) in the observation group were higher than those in the control group at 1 and 3 d after the operation(all P<0.05).Conclusion:Laparoscopic appendectomy for perforated appendicitis in children has faster postoperative recovery and fewer complications,which can improve postoperative inflammatory stress response and immune function.