摘要
目的:探究腹腔镜手术在重症急性胰腺炎(SAP)合并周围组织坏死感染患者治疗中的应用价值。方法:选取2020年9月—2023年3月某院收治的78例SAP合并周围组织坏死感染患者,采用电脑随机法分为观察组和对照组,各39例。观察组行腹腔镜手术,对照组行常规开腹手术。比较2组手术相关指标、炎症-应激因子[C反应蛋白(CRP)、降钙素原(PCT)、皮质醇(COR)、去甲肾上腺素(NE)]、胃肠功能(胃泌素、胃动素、肠鸣音恢复时间)、术后并发症及住院期间病死率。结果:观察组手术时间、初次下床活动时间、术中出血量、术后引流量及住院天数[(69.58±11.32)min、(1.23±0.11)d、(55.43±6.22)mL、(359.44±58.54)mL、(8.95±1.49)d]均少于对照组[(125.47±18.54)min、(2.18±0.42)d、(177.65±15.43)mL、(583.99±75.31)mL、(14.28±1.55)d](P<0.05);观察组血清CRP、PCT、COR、NE术后1 d分别为(153.31±18.13)ng/mL、(4.38±0.72)mg/mL、(206.84±22.37)μg/L、(265.87±35.74)μg/L,术后3 d分别为(55.79±12.14)ng/mL、(1.98±0.49)mg/mL、(63.97±16.13)μg/L、(72.59±20.21)μg/L,均低于对照组[术后1 d:(174.37±19.21)ng/mL、(5.15±0.75)mg/mL、(244.59±23.45)μg/L、(324.87±36.22)μg/L;术后3 d:(84.36±11.32)ng/mL、(2.47±0.51)mg/mL、(81.66±15.41)μg/L、(93.68±21.44)μg/L](P<0.05);观察组胃动素、胃泌素水平术后1 d分别为(200.19±25.22)ng/L、(16.25±2.11)ng/L,术后3 d分别为(228.47±28.31)ng/L、(19.34±2.37)ng/L,均高于对照组[术后1 d:(177.68±24.31)ng/L、(13.89±2.21)ng/L;术后3 d:(198.95±25.74)ng/L、(16.58±2.54)ng/L](P<0.05),观察组肠鸣音恢复时间[(12.98±3.75)h]短于对照组[(18.76±4.11)h],差异均有统计学意义(P<0.05)。观察组术后并发症总发生率、住院期间病死率与对照组比较,差异无统计学意义(P>0.05)。结论:腹腔镜手术治疗SAP合并周围组织坏死感染患者,能减少术中出血,减轻炎性-应激反应,改善胃肠功能,有利于促进术后早期病情恢复,且安全性较高。
Objective:To explore the application value of laparoscopic surgery in the treatment of severe acute pancreatitis(SAP)patients with surrounding tissue necrosis and infection.Methods:A total of 78 patients with SAP combined with peripheral tissue necrosis infection admitted to our hospital from 2020 to 09 to 2023 to 03 were randomly divided into observation group and control group,39 cases in each group.The observation group underwent laparoscopic surgery,and the control group underwent conventional open surgery.Compare surgical related indicators,inflammatory stress factors[C-reactive protein(CRP),procalcitonin(PCT),cortisol(COR),norepinephrine(NE)],gastrointestinal function(gastrin,motilin,bowel sound recovery time),postoperative complications,and in-hospital mortality between two groups.Results:The operation time,initial ambulation time,intraoperative blood loss,postoperative drainage volume,and hospitalization days in the observation group were(69.58±11.32)minutes,(1.23±0.11)days,(55.43±6.22)ml,(359.44±58.54)ml,and(8.95±1.49)days,respectively,which were all shorter(less)than those in the control group[(125.47±18.54)minutes,(2.18±0.42)days,(177.65±15.43)ml,(583.99±75.31)ml,(14.28±1.55)days](P<0.05);the serum CRP,PCT,COR,and NE in the observation group on day 1 after surgery were(153.31±18.13)ng/mL,(4.38±0.72)mg/mL,(206.84±22.37)μg/L,and(265.87±35.74)μg/L,respectively,and were(55.79±12.14)ng/mL,(1.98±0.49)mg/mL,(63.97±16.13)μg/L,and(72.59±20.21)μg/L,respectively,on day 3 after surgery,which were all lower than those in the control group on day 1 after surgery[(174.37±19.21)ng/mL,(5.15±0.75)mg/mL,(244.59±23.45)μg/L,(324.87±36.22)μg/L]and on day 3 after surgery[(84.36±11.32)ng/mL,(2.47±0.51)mg/mL,(81.66±15.41)μg/L,(93.68±21.44)μg/L].g/L](P<0.05);the levels of motilin and gastrin in the observation group were(200.19±25.22)ng/L and(16.25±2.11)ng/L on day 1 after surgery,and(228.47±28.31)ng/L and(19.34±2.37)ng/L on day 3 after surgery,both of which were higher than the control group's levels of[(177.68±24.31)ng/L and(13.89±2.21)ng/L]on day 1 after surgery,and[(198.95±25.74)ng/L and(16.58±2.54)ng/L]on day 3 after surgery,the recovery time of bowel sounds in the observation group was(12.98±3.75)hours,which was shorter than the control group's[(18.76±4.11)hours](P<0.05);there was no significant difference in the total incidence of postoperative complications and in-hospital mortality between the observation group and the control group(P>0.05).Conclusion:Laparoscopic surgery in the treatment of SAP patients with peripheral tissue necrosis infection can optimize surgery,reduce inflammatory stress response,improve gastrointestinal function,and promote early postoperative recovery,with high safety.
作者
郭凯
王艳瑛
陈向东
Guo Kai;Wang Yanying;Chen Xiangdong(Zhumadian Central Hospital,Henan Zhumadian 463000)
出处
《淮海医药》
CAS
2024年第5期492-495,共4页
Journal of Huaihai Medicine
关键词
重症急性胰腺炎
组织坏死感染
腹腔镜手术
血清炎症因子
胃肠功能
Severe acute pancreatitis
Tissue necrosis infection
Laparoscopic surgery
Inflammatory stress factor
Gastrointestinal function
Security
