腹腔镜微创与开放修补术对老年消化道溃疡穿孔患者机体应激反应、免疫功能及血清炎症因子水平的影响

目的 探讨腹腔镜微创与开放修补术对老年消化道溃疡穿孔患者机体应激反应、免疫功能及血清炎症因子水平的影响.方法 采用随机数字表法将2014年10月至2016年1 1月我院收治的80例老年消化道溃疡穿孔患者分为对照组及实验组两组,每组40例,两组分别实施传统开放修补术及腹腔镜微创手术,观察两组手术相关指标、术前术后应激反应指标血清降钙素原(PCT)]、免疫反应指标T淋巴细胞亚群(CD4+、CD8+)及自然杀伤细胞(NK)]、血清炎症因子白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)]的变化.结果 实验组住院时间较对照组明显缩短,并发症发生率较对照组明显降低(P＜0.05),而两组手术时间相比较,差异无统计学意义(P＞0.05);术前两组PCT、CD4+、CD8+、NK、IL-1、IL-6、TNF-α相比较,差异无统计学意义(P＞0.05);术后1天两组PCT较术前明显升高(P＜0.05),术后2、7天实验组PCT与术前相比较,差异无统计学意义,且术后1、2天实验组PCT较对照组明显降低(P＜0.05);此外术后1、2天对照组CD4+、CD8+、NK较术前明显降低,IL-1、IL-6、TNF-α较术前明显升高,而实验组对应指标仅术后1天分别较术前显著降低、升高,且术后实验组各项指标较对照组更早恢复至术前水平(P＜0.05).结论 腹腔镜微创术治疗老年消化道溃疡穿孔患者住院时间更短且术后并发症发生率更低,此外由其所引起的机体应激反应、免疫功能损害及炎症反应较开放修补术明显减轻.

Effect of Laparoscopic Minimally Invasive Surgery and Open Repair on the Stress Response,Immune Function and Levels of Serum Inflammatory Factors in Elderly Patients with Ulcerous Perforation of Digestive Tract

Objective To investigate the effect of laparoscopic minimally invasive surgery and open repair on the stress response,immune function and levels of serum inflammatory factors in elderly patients with ulcerous perforation of digestive tract.Methods 80 cases of elderly patients with ulcerous perforation of digestive tract treated in our hospital from October 2014 to November 2016 were randomly selected and divided into the control group and the experimental group by random number table method,40 cases in each group.The two groups were treated with traditional open repair and laparoscopic minimally invasive surgery,respectively.The operation related indexes,stress response indexes serum procalcitonin(PCT)],immune response indexes T lymphocyte subsets (CD4 +,CD8 +),natural killer cells (NK)] and serum inflammatory factors interleukin-1 (IL-1),interleukin-6 (IL-6),tumor necrosis factor α (TNF-α)] in the two groups were analysed before and after treatment.Results The hospitalization time of the experimental group was significantly shorter than that of the control group,and the incidence of complications was significantly lower than that in the control group (P ＜ 0.05),but there was no significant difference in the operation time between the two groups (P ＞ 0.05).There was no significant difference in PCT,CD4 +,CD8 +,NK,IL-1,IL-6 and TNF-α between the two groups before operation (P ＞ 0.05).1 day after operation,PCT levels in the two groups significantly increased (P ＜ 0.05).There was no significant difference in PCT levels in the experimental group at 2 days and 7 days after operation,compared with those before operation.1 day and 2 days after operation,PCT levels were significantly lower in the experimental group than those in the control group (P ＜ 0.05).1 day and 2 days after operation,CD4 +,CD8 + and NK in two groups significantly decreased,while IL-1,IL-6 and TNF-α significantly increased.After operation,the indexes in experimental group were better than those in the control group (P ＜ 0.05).Conclusion The application of laparoscopic minimally invasive surgery in the treatment of elderly patients with ulcerous perforation of digestive tract can shorten the length of hospital stay and reduce the incidence of postoperative complications.The induced stress response,immune function damage and inflammation are mild.