腹腔镜手术治疗胃十二指肠穿孔伴高血压的疗效及对应激反应、免疫功能的影响

目的:探讨腹腔镜手术治疗胃十二指肠穿孔伴高血压的疗效及对应激反应、免疫功能的影响。方法:选择84例胃十二指肠穿孔伴高血压的患者,以入院病例号为编号,根据随机数字表随机分为观察组(行腹腔镜手术)与对照组(行开腹穿孔修补术),观察手术疗效,并记录临床相关指标及实验室指标,包括应激反应指标(CRP、IL-6、IL-10)、T细胞亚群。结果:两组总有效率差异无统计学意义(P0.05);观察组术中出血量、术后排气时间、胃肠道功能恢复时间及住院时间较对照组短,手术时间较长,与对照组相比差异有统计学意义(P0.05);两组术后并发症发生率差异无统计学意义(P0.05)。术中观察组患者的血压波动幅度小,优于对照组(P0.05);术后观察组CRP、IL-6、IL-10水平优于对照组(P0.05);术后第1天,两组CD4~+均下降,但对照组较观察组明显降低(P0.05);第5天,观察组CD4~+/CD8~+水平仍优于对照组(P0.05)。结论:腹腔镜手术治疗胃十二指肠穿孔伴高血压在保证疗效的前提下,手术过程中血压稳定,对免疫功能影响小,应激反应程度轻,更利于术后恢复。

The curative effect of laparoscopic surgery in the treatment of gastroduodenal perforation with hypertension and its influence on stress response and immune function

Objective:To explore the effect of laparoscopic surgery in the treatment of gastroduodenal perforation with hyperten-sion and the influence on stress response and immune function.Methods:Eighty-four cases of gastroduodenal perforation with hyperten-sion were selected,who were randomly divided into observation group ( laparoscopic surgery) and control group ( open repair of perfora-tion) according to the random number table.The curative effect of surgery was observed,and the related indexes and laboratory indexes were recorded ,including stress response indexes (CRP,IL-6,IL-10) and T cell subsets.Results:In both groups,the total efficiency were not statistically significantly different (P>0.05),the intraoperative bleeding volume,postoperative exhaust time,gastrointestinal function recovery time and hospitalization time of observation group were shorter than those of the control group,but the operation time was longer compared with the control group (P<0.05).There was no difference in the incidence of postoperative complications be-tween the two groups (P>0.05).During the operation,the blood pressure of patients in observation group was significantly more sta-ble;The postoperative levels of CRP,IL-6 and IL-10 were better than those of the control group (P<0.05).On the first day after oper-ation,CD4 +of the two groups were decreased,the control group was significantly lower (P<0.05).On the fifth day,the CD4 +/CD8 +level of the observation group was still better than that of the control group (P<0.05).Conclusions:Laparoscopic surgery can ensure the therapeutic effect in the treatment of gastroduodenal perforation with hypertension.This procedure has advantages of stable blood pressure during operation,little influence on immune function and mild stress reaction,is more conducive to postoperative recovery.