腹腔镜手术治疗化脓性阑尾炎患儿的效果及对其术后免疫和应激反应的影响

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　　【摘要】 目的：探究腹腔鏡手术治疗化脓性阑尾炎患儿的效果及对其术后免疫和应激反应的影响。方法：选取2015年4月-2018年4月本院收治的268例化脓性阑尾炎患儿作为研究对象，所有患儿按照手术方法分为试验组和对照组，对照组55例行传统开腹手术，试验组213例行腹腔镜手术。记录并对比两组患儿手术时间、手术出血量及术后排气时间;测量并对比两组患儿术前和术后7 d血液中淋巴细胞、中性粒细胞及白细胞数量;测量并比较两组患儿术前和术后1 d的血清中C反应蛋白、IL-6、IL-8水平;对比两组患儿下床活动时间、肠胃功能恢复时间及住院时间;对比两组患儿切口感染、腹腔脓肿、粘连性肠梗阻等不良反应的发生率。结果：两组患儿手术时间比较，差异无统计学意义（P>0.05）;试验组患儿手术出血量及术后排气时间均显著低于对照组（P<0.05）;两组患儿术后7 d淋巴细胞、中性粒细胞、白细胞均显著低于术前，且试验组均显著低于对照组（P<0.05）;术后1 d，两组患儿C反应蛋白、IL-6、IL-8均显著高于术前，但试验组均显著低于对照组（P<0.05）;试验组患儿下床活动时间、肠胃功能恢复时间及住院时间均显著短于对照组（P<0.05）;试验组并发症发生率显著低于对照组（P<0.05）。结论：腹腔镜手术治疗小儿化脓性阑尾炎临床效果更好，能显著减轻手术创伤、加快患儿恢复、并发症少，且术后免疫反应及应激反应比传统开腹手术轻。
　　 【关键词】 腹腔镜手术; 化脓性阑尾炎; 免疫反应; 应激反应
　　【Abstract】 Objective：To explore the effect of laparoscopic surgery on children with suppurative appendicitis and its effect on postoperative immune and stress responses.Method：268 children were selected as the research objects who were admitted to our hospital with purulent appendicitis from April 2015 to April 2018.All children were divided into experimental group and control group according to surgical methods，55 patients in the control group underwent traditional laparotomy，and 213 patients in the experimental group underwent laparoscopic surgery.The operation time，surgical blood loss and postoperative exhaust time of the two group were recorded and compared.Besides，the numbers of lymphocytes，neutrophils and leukocytes in the blood of the two groups were measured and compared before and 7 days after surgery，and serum levels of c-reactive protein，IL-6 and IL-8 were did so between the two groups before and one day after surgery.In addition，the time of getting out of bed，gastrointestinal dysfunction and hospitalization were compared between the two groups.The total incidence of incision infection，abdominal abscess，intestinal obstruction，mesenteric adhesion and other adverse reactions were compared between the two groups.Result：There was no significant difference in operation time between the two groups（P>0.05）.The amount of blood loss and postoperative exhaust time in the experimental group were significantly lower than those in the control group（P<0.05）.Lymphocytes，neutrophils and leukocytes of the two groups were significantly lower 7 days after surgery than those before surgery，and the experimental group were significantly lower than those in control group（P<0.05）.C-reactive protein，IL-6 and IL-8 were significantly higher in the two groups one day after surgery than those before treatment，and the experimental group were significantly shorter than those in the control group（P<0.05）.The time of getting out of bed，gastrointestinal dysfunction and hospitalization in the experimental group were significantly shorter than those in the control group（P<0.05）.The incidence of complications in the experimental group was significantly lower than that in the control group（P<0.05）.Conclusion：Laparoscopic surgery for pediatric suppurative appendicitis has better clinical effect，which can significantly reduce surgical trauma，speed up the recovery of patients and lessen complications as well as lighten postoperative immune response and stress response than traditional open surgery.
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