改良腹腔镜术与传统腹腔镜术治疗急性化脓性阑尾炎对患者围术期的影响

The perioperative effect of modified laparoscopic surgery and traditional laparoscopic surgery in the treatment of acute suppurative appendicitis

目的探讨改良腹腔镜术与传统腹腔镜术治疗急性化脓性阑尾炎(ASA)对患者围术期指标、疼痛程度、炎症反应、应激指标、凝血功能的影响。方法选取我院2019年2月~2022年2月收治的86例ASA患者,按手术方法不同,分为改良腹腔镜组(n=43)、传统腹腔镜组(n=43)。传统腹腔镜组接受传统的腹腔镜术式治疗,改良腹腔镜组接受改良的腹腔镜单切口术式治疗。对比两组围术期指标、手术前后阑尾炎炎症反应(AIR)、视觉模拟评分法(VAS)评分、应激指标[超氧化物歧化酶(SOD)、皮质醇(Cor)、丙二醛(MDA)、促肾上腺皮质激素(ACTH)]、凝血功能指标[血栓素B2(TXB2)、6-酮-前列腺素1α(6-keto-PGF1α)、内皮素-1(ET-1)]水平。结果改良腹腔镜组术中失血量少于传统腹腔镜组,首次排气时间、首次进食时间、术后首次下床活动时间、胃肠功能恢复时间短于传统腹腔镜组,但手术耗时长于传统腹腔镜组(P<0.05);术后1d,改良腹腔镜组AIR、VAS评分低于传统腹腔镜组(P<0.05);术后1d、3d,改良腹腔镜组血清SOD水平高于传统腹腔镜组,血清MDA、Cor、ACTH水平低于传统腹腔镜组(P<0.05);术后1d、3d,改良腹腔镜组血清TXB2、ET-1水平低于传统腹腔镜组,血清6-keto-PGF1α水平高于传统腹腔镜组(P<0.05);改良腹腔镜组美观总满意度(97.67%)高于传统腹腔镜组(81.40%)(P<0.05)。结论相较于传统的腹腔镜术式,应用改良的腹腔镜单切口术式治疗ASA患者更有助于减少术中失血量,减轻术后疼痛感,减轻机体的应激反应及凝血功能,促进患者术后身体恢复,但手术耗时略长。

Objective To investigate the effects of modified laparoscopy and traditional laparoscopy in the treatment of acute suppurative appendicitis(ASA) on perioperative indicators,pain degree,inflammatory response,stress indicators and blood coagulation function.Methods From February 2019 to February 2022,a total of 86 ASA patients admitted to the hospital were divided into the modified laparoscopy group(n= 43) and the traditional laparoscopy group(n= 43) according to different surgical methods. The traditional laparoscopic group received the traditional laparoscopic surgery,while the modified laparoscopic group received the modified laparoscopic single incision surgery. The perioperative indicators,appendicitis inflammatory response(AIR) before and after operation,visual analogue scale(VAS) score,stress indicators,including superoxide dismutase(SOD),cortisol(Cor),malondialdehyde(MDA) and adrenocorticotropic hormone(ACTH),as well as coagulation function indicators,including thromboxane B2(TXB2),6-keto-prostaglandin-1α(6-keto-PGF1 α) and Endothelin-1(ET-1) of two groups were compared.Results The blood loss during operation in the improved laparoscopy group was less than that in the traditional laparoscopy group,and the time of first exhaust,first eating,first activity out of bed after operation,and gastrointestinal function recovery were shorter than those in the traditional laparoscopy group,but the operation time was longer than that in the traditional laparoscopy group(P<0. 05);One day after operation,AIR and VAS scores in the modified laparoscopic group were lower than those in the traditional laparoscopic group(P<0. 05);On the 1st and 3rd day after operation,the serum SOD level in the modified laparoscopic group was higher than that in the traditional laparoscopic group,and the serum MDA,Cor,ACTH levels were lower than those in the traditional laparoscopic group(P<0. 05);On the 1st and 3rd day after operation,the serum TXB2 and ET-1levels in the modified laparoscopic group were lower than those in the traditional laparoscopic group,and the serum 6-keto-PGF1 α was higher than that of the traditional laparoscopy group(P<0. 05);The total aesthetic satisfaction of the improved laparoscopic group(97. 67%) was higher than that of the traditional laparoscopic group(81. 40%,P<0. 05).Conclusion Compared with the traditional laparoscopic operation,the modified laparoscopic single incision operation is more helpful to reduce the blood loss during the operation,relieve the pain after the operation,reduce the stress reaction and blood coagulation function of the body,and promote the recovery of the patients after the operation,but the operation takes a little longer.