手助腹腔镜与开腹巨脾切除术对机体应激反应的影响

目的:总结手助腹腔镜与开腹巨脾切除术对患者术后机体应激反应的影响。方法:随机选取2006年8月至2011年10月40例巨脾患者,根据其经济状况及意愿分为两组,每组20例,分别行手助腹腔镜脾切除术(hand-assisted laparo-scopic splenectomy,HALS)及传统开腹脾切除术(open splenectomy,OS),对比分析两组患者术前、术后皮质醇(cortisol,COR)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、C-反应蛋白(C-reactive protein,CRP)水平。结果:术后1天HALS组COR、TNF-α、IL-6、CRP水平均低于OS组(P<0.05),术后3天TNF-α、CRP水平低于OS组(P<0.05),术后5天CRP低于OS组(P<0.01)。结论:相对开腹手术而言,手助腹腔镜巨脾切除术对患者术后机体应激反应的影响较小,充分显示了其微创的优越性。

Effects of hand-assisted laparoscopic splenectomy and open splenectomy for giant spleens on systemic stress responses

Objective:To summarize the influences of hand-assisted laparoscopic splenectomy and open splenectomy for giant spleens on systemic stress response.Methods:Forty patients diagnosed as giant spleens from Aug.2006 to Oct.2011 were divided into two groups according to their economic status and will,20 cases were operated by hand-assisted laparoscopic splenectomy(HALS),and the other 20 cases were operated by open splenectomy(OS).Plasma levels of cortisol(COR),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6) and C-reactive protein(CRP) were measured before and after surgery and comparatively analyzed.Results:The mean value of laboratory test of HALS group was significantly less than that of OS group in such indexes as plasma levels of COR,TNF-α,IL-6 and CRP on the 1st day after operation(P<0.05),TNF-α and CRP on the 3rd day after operation(P<0.05),CRP on the 5th day after operation.(P<0.01).Conclusions:Compared with open splenectomy,hand-assisted laparoscopic splenectomy for giant spleens has the advantages of less systemic stress response and more minimal invasiveness.