腹腔镜阑尾切除术治疗小儿阑尾炎术后感染研究
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摘要
目的探究开腹与腹腔镜阑尾切除术治疗小儿阑尾炎术后感染及对血清炎症因子、免疫功能及T淋巴细胞亚型的影响。方法选取2013年1月-2016年12月医院收治的200例小儿阑尾炎患儿作为研究对象,按照手术类型分为开腹切除组和腹腔镜切除组,每组100例;统计两组患儿的手术指标;术后出现切口感染、腹腔脓肿及粘连性肠梗阻的概率;血清炎症因子及可溶性细胞间黏附分子-1(sICAM-1)的含量;统计两组患儿手术前及术后1周外周血中的白细胞(WBC)数目、中性粒细胞(N)数目及淋巴细胞(L)数目及CD_4~+、CD_8~+T细胞的比例。结果与开腹切除组患儿相比,腹腔镜切除组患儿的术后排气时间、抗菌药物使用时间及住院时间减少;术后发生切口感染、腹腔脓肿及粘连性肠梗阻的比例均减少(P<0.05);手术后1周,腹腔镜切除组患儿血清中炎症因子水平降低(P<0.05);sICAM-1含量显著降低(P<0.05);CD_4~+T细胞百分比及CD_4~+/CD_8~+增加(P<0.05)。结论腹腔镜切除术治疗小儿阑尾炎具有良好的临床效果,术后并发症较少且恢复较快,能够显著改善患儿术后炎症因子、免疫功能及T淋巴细胞亚型。
OBJECTIVE To explore the clinical effect of laparotomy and laparoscopic appendectomy on treatment of the appendicitis children with postoperative infection and analyze the influence on serum inflammatory factors,immune function and T lymphocyte subsets.METHODS A total of 200children with appendicitis who were treated in the hospital from Jan 2013to Dec 2016were recruited as the study objects and divided into the laparotomy group and the laparoscopic appendectomy group,with 100cases in each group.The surgical indexes of the two groups of children were statistically analyzed,the incidence rates of postoperative incision infection,intraabdominal abscess and adhesive intestinal obstruction were analyzed,the levels of serum inflammatory factors and soluble intercellular adhesion molecule-1(sICAM-1)were detected,and the peripheral blood white blood cell(WBC)counts,neutrophils(N)counts and percentages of CD_4~+,CD_8~+T were statistically analyzed before the surgeries and after the surgeries for 1week.RESULTS The postoperative exhaust time,time of use of antibiotics and length of hospital stay were significantly shorter in the laparoscopic appendectomy group than in the laparotomy group;the proportions of the patients who had postoperative incision infection,intraabdominal abscess and adhesive intestinal obstruction were significantly reduced(P<0.05).The levels of serum inflammatory factors of the laparoscopic appendectomy group were significantly reduced after the surgery for 1week(P<0.05);the sICAM-1level was significantly reduced(P<0.05);the percentage of CD_4~+T cell and CD_4~+/CD_8~+were significantly increased(P<0.05).CONCLUSION The laparoscopic appendectomy can achieve remarkable effect on treatment of the children with appendicitis and significantly improve the postoperative inflammatory factors,immune function and T lymphocyte subsets,the incidence of postoperative complications is low,and the recovery is rapid.
OBJECTIVE To explore the clinical effect of laparotomy and laparoscopic appendectomy on treatment of the appendicitis children with postoperative infection and analyze the influence on serum inflammatory factors,immune function and T lymphocyte subsets.METHODS A total of 200children with appendicitis who were treated in the hospital from Jan 2013to Dec 2016were recruited as the study objects and divided into the laparotomy group and the laparoscopic appendectomy group,with 100cases in each group.The surgical indexes of the two groups of children were statistically analyzed,the incidence rates of postoperative incision infection,intraabdominal abscess and adhesive intestinal obstruction were analyzed,the levels of serum inflammatory factors and soluble intercellular adhesion molecule-1(sICAM-1)were detected,and the peripheral blood white blood cell(WBC)counts,neutrophils(N)counts and percentages of CD_4~+,CD_8~+T were statistically analyzed before the surgeries and after the surgeries for 1week.RESULTS The postoperative exhaust time,time of use of antibiotics and length of hospital stay were significantly shorter in the laparoscopic appendectomy group than in the laparotomy group;the proportions of the patients who had postoperative incision infection,intraabdominal abscess and adhesive intestinal obstruction were significantly reduced(P<0.05).The levels of serum inflammatory factors of the laparoscopic appendectomy group were significantly reduced after the surgery for 1week(P<0.05);the sICAM-1level was significantly reduced(P<0.05);the percentage of CD_4~+T cell and CD_4~+/CD_8~+were significantly increased(P<0.05).CONCLUSION The laparoscopic appendectomy can achieve remarkable effect on treatment of the children with appendicitis and significantly improve the postoperative inflammatory factors,immune function and T lymphocyte subsets,the incidence of postoperative complications is low,and the recovery is rapid.
引文
[1]Svensson JF,Patkova B,Almstrom M,et al.Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children:apilot randomized controlled trial[J].Ann Surg,2015,261(1):67-71.
[2]王子卫,魏正强,蔡建辉,等.小病不可小视-《急性阑尾炎诊断》标准解读[J].中国卫生标准管理,2011,2(4):17-18.
[3]中华人民共和国卫生部.医院感染诊断标准(试行)摘登(1)[J].中华医学杂志,2001,85(5):314-320.
[4]卢宗耀,冯力.小儿急性阑尾炎的腹腔镜手术治疗研究[J].现代中西医结合杂志,2014,23(2):153-155.
[5]侯崇智,冯雪.腹腔镜治疗小儿阑尾炎穿孔的临床效果分析[J].临床和实验医学杂志,2015,14(15):1306-1309.
[6]Sarsu SB,Yllmaz SG,Bayram A,et al.Polymorphisms in the IL-6and IL-6Rreceptor genes as new diagnostic biomarkers of acute appendicitis:a study on two candidate genes in pediatric patients with acute appendicitis[J].Ital J Pediatr,2015,41(1):100.
[7]Zviedre A,Engelis A,Tretjakovs P,et al.Role of serum cytokines in acute appendicitis and acute mesenteric lymphadenitis among children[J].Medicina(Kaunas),2016,52(5):291-297.
[8]段春胜,周丽霞,王军辉,等.腹腔镜治疗对急性化脓性阑尾炎患儿血清slCAM-1与IL-8和TNF-α水平及免疫功能的影响[J].中华医院感染学杂志,2017,27(14):3323-3326.
[9]王军,曹斌校,李绍刚,等.腹腔镜对急性阑尾炎腹内感染患儿炎症因子水平和免疫功能的临床影响研究[J].中华医院感染学杂志,2016,26(22):5213-5215.
[10]贾成功,吴军,史传文.腹腔镜手术治疗复杂性阑尾炎对患者T淋巴细胞亚群的影响研究[J].腹腔镜外科杂志,2016,21(9):696-699.
[11]包小周,秦乐,林孝坤,等.大黄牡丹汤对腹腔镜手术后阑尾炎患儿炎症因子和免疫功能的影响[J].中医儿科杂志,2016,12(6):71-74.
[2]王子卫,魏正强,蔡建辉,等.小病不可小视-《急性阑尾炎诊断》标准解读[J].中国卫生标准管理,2011,2(4):17-18.
[3]中华人民共和国卫生部.医院感染诊断标准(试行)摘登(1)[J].中华医学杂志,2001,85(5):314-320.
[4]卢宗耀,冯力.小儿急性阑尾炎的腹腔镜手术治疗研究[J].现代中西医结合杂志,2014,23(2):153-155.
[5]侯崇智,冯雪.腹腔镜治疗小儿阑尾炎穿孔的临床效果分析[J].临床和实验医学杂志,2015,14(15):1306-1309.
[6]Sarsu SB,Yllmaz SG,Bayram A,et al.Polymorphisms in the IL-6and IL-6Rreceptor genes as new diagnostic biomarkers of acute appendicitis:a study on two candidate genes in pediatric patients with acute appendicitis[J].Ital J Pediatr,2015,41(1):100.
[7]Zviedre A,Engelis A,Tretjakovs P,et al.Role of serum cytokines in acute appendicitis and acute mesenteric lymphadenitis among children[J].Medicina(Kaunas),2016,52(5):291-297.
[8]段春胜,周丽霞,王军辉,等.腹腔镜治疗对急性化脓性阑尾炎患儿血清slCAM-1与IL-8和TNF-α水平及免疫功能的影响[J].中华医院感染学杂志,2017,27(14):3323-3326.
[9]王军,曹斌校,李绍刚,等.腹腔镜对急性阑尾炎腹内感染患儿炎症因子水平和免疫功能的临床影响研究[J].中华医院感染学杂志,2016,26(22):5213-5215.
[10]贾成功,吴军,史传文.腹腔镜手术治疗复杂性阑尾炎对患者T淋巴细胞亚群的影响研究[J].腹腔镜外科杂志,2016,21(9):696-699.
[11]包小周,秦乐,林孝坤,等.大黄牡丹汤对腹腔镜手术后阑尾炎患儿炎症因子和免疫功能的影响[J].中医儿科杂志,2016,12(6):71-74.