腹腔镜治疗小儿穿孔性阑尾炎对血清C反应蛋白和降钙素原的影响

目的比较腹腔镜与开腹手术治疗小儿穿孔性阑尾炎手术前后血清C反应蛋白（C—reactive protein，CRP）和降钙素原（procalcitonin，PCT）的变化。方法采用前瞻性对照研究方法，将2010年6月～2012年10月临床诊断为穿孔性阑尾炎的78例患儿按家属意愿分为开放组（38例）和腹腔镜组（40例）。分别于术前0．5h、术后24h及48h采外周静脉血，分别用ELISA法和胶体免疫结合法测定血清CRP和PCT。结果2组血清CRP和PCT术前差异无显著性（P〉0．05）；术后24h较术前均明显升高（P〈0．05），开放组CRP升高更明显（P=0．000）；术后48h腹腔镜组PCT已恢复至术前水平（P〉0．05），腹腔镜组CRP和开放组CRP、PCT仍高于术前（P〈0．05），且开放组明显高于腹腔镜组（P=0．000）。结论与开放手术相比，腹腔镜治疗小儿穿孔性阑尾炎引起CRP、PCT的变化较小。

Effect of Laparoscopic Surgery of Perforative Appendicitis on the Serum Level of CRP and PCT of Children

Objective To explore the changes of CRP and PTC levels after laparoscopic or open appendectomy in children who had perforative appendicitis. Methods A prospective case-control study was performed. Seventy-eight children who were diagnosed as perforative appendicitis between June 2010 and October 2012 were assigned into the open appendectomy group （ OA group） and laparoscopic appendectomy group （LA group） respectively at patients＇ or their parents＇ will. OA group and LA group included 38 and 40 cases respectively. The blood samples of all cases were collected half an hour before, 24 h and 48 h after the operation respectively. ELISA and immunochromatography assays were used to detect the levels of CRP and PCT respectively. Results There was no significant difference between LA group and OA group in the preoperative levels of CRP and PCT（ P 〉 0.05 ）. Compared to preoperative levies, the levels of CRP and PCT were significantly increased 24 h after surgery in both groups （ P 〈 0.05） with the levels of CRP in OA group being significantly higher than those in LA group（P = 0. 000）. The levels of PCT in LA group 48 h after operation returned to preoperative levels （ P 〉 0.05 ） while the levels of CRP in LA group and the levels of CRP, PCT in OA group remained significantly higher than preoperative levels（P 〈 0.05）. Moreover, the levels of CRP and PCT in OA group 48 h after operation were significantly higher than those in LA group（P = 0. 000）. Conclusion Compared with open surgery, the changes of CRP and PCT after laparoscopic surgery were minor.