分步骤区域腹腔冲洗在老年上消化道穿孔手术患者中的应用效果

目的:观察分步骤区域腹腔冲洗在老年上消化道穿孔手术患者中的应用效果。方法:选取77例老年上消化道穿孔患者作为研究对象,按随机数字表法分为对照组(n=38)和观察组(n=39)。两组患者均行腹腔镜下穿孔修补术,术中对照组行常规腹腔冲洗,观察组行分步骤区域腹腔冲洗。比较两组手术相关指标水平、手术前后血清炎性因子水平和并发症发生率。结果:观察组手术时间和住院时间均短于对照组,术后排气时间早于对照组,术后引流量少于对照组,差异均有统计学意义(P<0.05);术前,两组白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平比较,差异均无统计学意义(P>0.05);术后7 d,两组IL-6、CRP和TNF-α水平均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为7.69%(3/39),低于对照组的31.58%(12/38),差异有统计学意义(P<0.05)。结论:分步骤区域腹腔冲洗应用于老年上消化道穿孔手术患者可缩短手术时间、术后排气时间和住院时间,减少术后引流量,以及降低血清炎性因子水平和并发症发生率,其效果优于常规腹腔冲洗。

Application effects of step-by-step regional peritoneal irrigation in elderly patients with upper digestive tract perforation surgery

Objective:To investigate application effects of step-by-step regional peritoneal irrigation in elderly patients with upper digestive tract perforation surgery.Methods:77 elderly patients with upper digestive tract perforation were selected as the research objects,and were divided into control group(n=38)and observation group(n=39)according to the random number table method.Both groups underwent laparoscopic perforation repair.During the surgery,the control group underwent routine peritoneal irrigation,while the observation group was given the step-bystep regional peritoneal irrigation.The levels of surgery-related indicators,serum inflammatory factors levels before and after the surgery and the incidence of complications were compared between the two groups.Results:The operation time and hospital stay of the observation group were shorter than those of the control group;the postoperative exhaust time was earlier than that of the control group;the postoperative drainage was less than that of the control group;and the differences were statistically significant(P<0.05).Before the surgery,there were no significant differences in the levels of interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α)between the two groups(P>0.05).However,7 days after the surgery,the levels of IL-6,CRP and TNF-α in the two groups were lower than those before the surgery;those of the observation group were lower than those of the control group;and the differences were statistically significant(P<0.05).The complication rate in the observation group was 7.69%(3/39),which was lower than 31.58%(12/38)in the control group,and the difference was statistically significant(P<0.05).Conclusions:The step-by-step regional peritoneal irrigation for the elderly patients with upper digestive tract perforation surgery can shorten the operation time,the postoperative exhaust time and the hospital stay,reduce the postoperative drainage,and reduce the serum inflammatory factor levels and the complication rate.Moreover,it is superior to routine peritoneal irrigation.