腹腔镜辅助胃修补术治疗急性胃穿孔的临床效果及其对炎性-应激因子、胃肠激素水平的影响

Clinical Efficacy of Laparoscopic-assisted Gastric Repair in Acute Gastric Perforation and Its Effects on Inflammatory-stress Factors and Gastrointestinal Hormone Levels

目的探讨腹腔镜辅助胃修补术治疗急性胃穿孔的临床效果及其对炎性-应激因子、胃肠激素水平的影响。方法将62例急性胃穿孔患者按手术方法不同分为观察组(n=31)与对照组(n=31)。观察组采用腹腔镜辅助胃修补术,对照组采用开腹修补术。比较2组手术相关指标及术后胃动力恢复情况、疼痛情况(VAS评分)、并发症发生情况,观察2组治疗前后胃肠激素[胃泌素(GAS)、胃动素(MOT)、生长抑素(SS)]、炎性因子[超敏-C蛋白反应(hs-CRP)、白介素-6(IL-6)、降钙素原(PCT)]、应激因子[多巴胺(DA)、肾上腺素(NE)、5-羟色胺(5-HT)]水平的变化。结果观察组住院时间,术中出血量,手术时间及术后并发症发生率、VAS评分、肛门排气时间、排便时间、肠鸣音恢复时间、hs-CRP水平、IL-6水平、PCT水平、DA水平、NE水平、5-HT水平较对照组显著减少(P<0.05),术后GAS、MOT、SS水平较对照组显著增加(P<0.05);2组术后引流管拔管时间相比差异无统计学意义(P>0.05)。结论与开腹修补术相比,腹腔镜辅助胃修补术治疗急性胃穿孔能减轻炎性应激反应,缓解疼痛,改善胃肠功能,促进恢复。

Objective To investigate clinical efficacy of laparoscopic-assisted gastric repair in acute gastric perforation and its effects on inflammatory-stress factors and gastrointestinal hormone levels.Methods 62 patients with acute gastric perforation were divided into the observation group(n=31)and the control group(n=31)based on different surgical procedures.The observation group underwent laparoscopic-assisted gastric repair,and the control group received laparotomy.The surgery-related indexes and postoperative gastric power recovery,pain scores(VAS score),and complications were compared in the 2 groups;gastrointestinal hormones[gastrin(GAS),motility(MOT),and somatostatin(SS)],inflammatory factors[hypersensitivity-C protein response(hs-CRP),interleukin-6(IL-6),and procalcitoninogen(PCT)],and the levels of stress factors[dopamine(DA),adrenaline(NE),5-hydroxytryptamine(5-HT)]were observed in the 2 groups.Results In the observation group,hospitalization time,intraoperative bleeding,operation time and incidence of postoperative complications,VAS score,anal exhaust time,defecation time,bowel sound recovery time,hs-CRP level,IL-6 level,PCT level,DA level,NE level,5-HT level were significantly reduced compared with the control group(P<0.05);postoperative GAS,MOT and SS levels were significantly increased compared with the control group(P<0.05);the difference in terms of postoperative drain removal time was not statistically significant between the two groups(P>0.05).Conclusions In the management of acute gastric perforation,laparoscopic-assisted gastric repair can reduce inflammatory stress,relieve pain,improve gastrointestinal function,and promote recovery.