腹腔镜肠粘连松解术与开腹手术治疗粘连性肠梗阻的效果对比及对机体应激反应的影响

Laparoscopic adhesiolysis vs open surgery for the treatment of adhesive intestinal obstruction: Outcomes and impact on host stress response

目的:比较腹腔镜肠粘连松解术与开腹手术治疗粘连性肠梗阻(AIO)的效果及对机体应激反应的影响。方法:回顾性分析本院于2017年6月～2018年6月收治的54例AIO患者临床资料,按照手术方式不同分为腔镜组33例与开腹组21例,腔镜组采用腹腔镜肠粘连松解术,开腹组采用传统开腹手术,比较两组手术治疗情况、机体应激反应[C-反应蛋白(CRP)、白介素-6(IL-6)、皮质醇(COR)、肾上腺素(E)水平]及术后并发症发生率。结果:两组手术时间比较差异无统计学意义(P>0.05),腔镜组术中出血量、下床活动时间、排气恢复时间、尿管拔除时间、住院时长均显著低于开腹组(P<0.05);两组术后血清CRP、IL-6、E、COR均呈先升高后降低趋势,且腔镜组在术后1 d、术后5 d血清CRP、IL-6、E、COR水平均显著低于开腹组同时间点(P<0.05);腔镜组术后并发症发生率3.03%,显著低于开腹组的28.57%(P<0.05)。结论:腹腔镜肠粘连松解术治疗AIO患者较传统开腹手术而言,能减小患者手术创伤,减轻机体应激反应,降低并发症风险,有利于患者术后恢复。

Objective:To compare the outcomes of laparoscopic intestinal adhesiolysis and open surgery for adhesive intestinal obstruction(AIO)and their impacts on host stress response.Methods:The clinical data of 54 AIO patients admitted to our hospital between June 2017 and June 2018 were retrospectively analyzed.According to surgical options,they were divided into the laparoscopic group(n=33)and the open surgery group(n=21).The laparoscopic group underwent laparoscopic intestinal adhesiolysis,and the open group underwent conventional laparotomy.The surgery,host stress response[levels of C-reactive protein(CRP),interleukin-6(IL-6),cortisol(COR),and adrenaline(E)]and occurrence of complications were compared between the two groups.Results:There was no significant difference in the operation time between the two groups(P>0.05).The blood loss,time to getting out of bed,time to bowel movement,time to withdrawal of urinary catheter,and length of hospital stay were significantly less or shorter in the laparoscopic group compared with the open surgery group(P<0.05).Serum levels of CRP,IL-6,E,and COR increased and then declined in the two groups;serum CRP,IL-6,E,and COR levels were significantly lower in the laparoscopic group compared with the open surgery group at 1 and 5 days after surgery,respectively(P<0.05).The postoperative complication rate was 3.03%in the laparoscopic group,significantly lower compared with open surgery group(28.57%)(P<0.05).Conclusion:Laparoscopic adhesiolysis for AIO patients may reduce the surgical trauma,host stress response,and risk of complications,and therefore is conducive for recover after surgery.