二氧化碳气腹腔镜与开腹手术对细菌性腹膜炎患者疗效的比较

目的:探讨二氧化碳气腹腔镜手术和开腹手术对细菌性腹膜炎术后全身炎症反应及细菌移位的影响,为未来提高细菌性腹膜炎的治疗效果提供参考。方法:66例细菌性腹膜炎患者,随机分为开腹手术组和腹腔镜手术组,每组33例。分别于术前、术后1 d和3 d测定血培养、白细胞总数、C-反应蛋白(CRP)、肿瘤坏死因子(TNF)和白介素(IL)-6的水平,观察切口感染及腹腔脓肿情况。结果:术前2组各项临床及检验指标无显著差异(P0.05)。术后肝、脾、肺、肾细菌移位的发生率在二组间亦无显著差别(P0.05)。但术后1 d及3 d,腹腔镜组白细胞总数和CRP、TNF、IL-6水平均显著低于开腹组(P0.05或P0.01)。结论:二氧化碳气腹腔镜手术与开腹手术对细菌性腹膜炎的短期疗效大体相似,但由于前者能更显著地减轻术后全身性炎症反应,因而是一种前景较好并值得进一步研究和推广的治疗手段。

Comparison of the Effects of Carbon Dioxide Pneumoperitoneum Laparoscopic Surgery and Laparotomy on Patients with Bacterial Peritonitis

ObjectiveTo explore the effects of carbon dioxide pneumoperitoneum laparoscopic surgery and laparotomy on systemic inflammatory reaction and bacterial translocation in patients with postoperative bacterial peritonitis, so as to provide a reference for improving the treatment of bacterial peritonitis. Methods66 patients with bacterial peritonitis were randomly divided into laparoscopic surgery group and laparotomy group, with 33 in each group. Blood culture, white cell count （WBC）, blood levels of C _ reactive protein （CRP）, tumour necrosis factor （TNF） and interleukin _ 6 （IL _ 6） before operation and 1 day or 3 days after operation were measured. Incidences of incisional infection and abdominal abscess were observed. ResultsThere was no signiifcant difference in clinical features and laboratory indices between the two groups before operation （allP〈0.05）. Similar incidences of bacterial translocation to liver, spleen, lungs and kidneys were observed in both groups （allP〉0.05）. Noticeably, blood levels of WBC, CRP, TNF and IL _6 were signiifcantly lower in patients of laparoscopic surgery group than those in laparotomy group （P〈0.05 orP〈0.01）.Conclusion Short _ term effects of carbon dioxide pneumoperitoneum laparoscopic surgery and laparotomy are similar on patients with bacterial peritonitis. However, systemic inlfammatory reaction can signiifcantly inhibited in patients treated by carbon dioxide pneumoperitoneum laparoscopic surgery, so this therapy is worth further research and promoting in clinical practice.