老年上消化道穿孔患者应用传统开腹与腹腔镜修补手术治疗对胃肠功能、应激反应的影响

Effects of two kinds of repair surgery on gastrointestinal function,stress response and complications in elderly patients with upper gastrointestinal perforation

目的:研究对比老年上消化道穿孔患者应用传统开腹与腹腔镜修补手术治疗对胃肠功能、应激反应的影响。方法:选取许昌市中心医院接受手术治疗的老年上消化道穿孔患者85例,根据手术方式不同分为传统组42例(行传统开腹修补术治疗)和腹腔镜组43例(实施腹腔镜修补术治疗),比较2组胃肠激素指标[胃泌素(GAS)、胃动素(MTL)、血管活性肠肽(VIP)]、应激因子[血清皮质酶(Cor)、hs-CRP、NE]、生化指标(CD4^(+)、CD8^(+)、WBC、IL-6)水平变化及并发症发生率。结果:术后3 d,腹腔镜组GAS、MTL、VIP水平[(98.76±7.41)μmol/L、(233.57±19.86)pg/L、(5.71±0.91)μmol/L]均优于传统组[(85.21±8.79)μmol/L、(189.63±20.51)pg/L、(3.77±0.84)μmol/L](P<0.05);术后24 h,腹腔镜组血清Cor、hs-CRP、NE水平[(235.46±23.31)ng/mL、(6.23±1.02)mg/L、(286.53±24.63)ng/mL]均低于传统组[(281.13±25.36)ng/mL、(8.61±1.22)mg/L、(320.21±25.54)ng/mL](P<0.05);术后24 h,腹腔镜组患者血清CD4^(+)水平[(26.79±2.52)g/L]高于传统组[(24.11±2.41)g/L](P<0.05),血清CD8^(+)、WBC、IL-6水平[(39.41±2.29)g/L、(12.93±1.26)×10^(9)/L、(6.74±1.21)ng/L]均低于传统组[(41.11±2.35)g/L、(13.21±1.30)×10^(9)/L、(7.38±1.20)ng/L](P<0.05)。腹腔镜组并发症发生率(9.31%)低于传统组(30.95%)(P<0.05)。结论:相较传统开腹修补术,老年上消化道穿孔患者采用腹腔镜修补术治疗应激反应更轻、胃肠激素水平恢复更快、并发症发生率更低,有助于胃肠功能恢复,安全性可。

Objective:To compare the effects of two types of repair surgery on gastrointestinal function,stress response and complications in elderly patients with upper gastrointestinal perforation.Methods:85 elderly patients with upper gastrointestinal perforation who received surgical treatment in a hospital were selected and divided into a traditional group(42 cases,treated with traditional open repair)and a laparoscopic group(43 cases,treated with laparoscopic repair).Changes of gastrointestinal hormone indexes,stress factors,biochemical indexes and incidence of complications were compared between the two groups.Results:3 days after operation,serum GAS,MTL and VIP levels in the two groups were lower than those before operation.The levels of each index of gastrointestinal hormones in the laparoscopic group were(98.76±7.41)μmol/L,(233.57±19.86)pg/L,and(5.71±0.91)μmol/L,higher than those in the traditional group(85.21±8.79)μmol/L,(189.63±20.51)pg/L,and(3.77±0.84)μmol/L(P<0.05).24 hours after operation,serum levels of Cor,hs-CRP and NE in the two groups were significantly increased compared with those before operation.Serum levels of Cor,hs-CRP and NE in the laparoscopy group were(235.46±23.31)ng/mL,(6.23±1.02)mg/L and(286.53±24.63)ng/mL,respectively,which were lower than those in the traditional group(281.13±25.36)ng/mL,(8.61±1.22)mg/L,and(320.21±25.54)ng/mL(P<0.05).24 hours after operation,serum CD4^(+)level in the laparoscopic group was(26.79±2.52)g/L,which was significantly higher than that in the traditional group(24.11±2.41)g/L(P<0.05),while serum CD8^(+),WBC and IL-6 levels in the laparoscopic group were(39.41±2.29)g/L,(12.93±1.26)×10^(9)/L,and(6.74±1.21)ng/L,lower than those of the traditional group's(41.11±2.35)g/L,(13.21±1.30)×10^(9)/L,and(7.38±1.20)ng/L(P<0.05).Complication rate in the laparoscopic group was 9.31%,significantly lower than the traditional group's 30.95%(P<0.05).Conclusion:Compared with traditional open repair,laparoscopic repair for elderly patients with upper gastrointestinal perforation has less stress response,faster recovery of gastrointestinal hormone levels,and lower incidence of complications,which is safe and helpful for the recovery of gastrointestinal function.