腹腔镜微创手术时机对感染性胰腺坏死患者疗效的影响

Effect of Timing of Laparoscopic Minimally Invasive Surgery on the Efficacy of Patients with Infectious Pancreatic Necrosis

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摘要目的探究不同腹腔镜微创手术时机对感染性胰腺坏死(IPN)患者治疗效果的影响。方法选取2020年6月至2023年6月收治的90例IPN患者,按行腹腔镜微创手术时机的不同分为早期手术组(第1~3日)48例和晚期手术组(第4~7日)42例,比较2组手术相关指标,比较2组术前术后急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)各维度评分、炎性因子和免疫功能指标水平,以及术后并发症发生率和病死率。结果早期手术组手术时间、术后排气时间、术后恢复饮食时间、住院时间均短于晚期手术组(P<0.05,P<0.01)。术后2组APACHEⅡ各维度评分均降低,且早期手术组低于晚期手术组(P<0.05,P<0.01)。术后2组中性粒细胞与淋巴细胞比值、C反应蛋白、白细胞介素-6水平降低,且早期手术组明显低于晚期手术组(P<0.05,P<0.01)。术后2组CD3+、CD4+水平均升高,CD8+水平均降低,且早期手术组CD8+水平明显低于晚期手术组,CD3+、CD4+水平明显高于晚期手术组(P<0.05,P<0.01)。早期手术组患者术后并发症发生率为27.08%(13/48)及病死率为2.08%(1/48)均低于晚期手术组的50.00%(21/42)、14.29%(6/42),差异有统计学意义(P<0.05)。结论早期行腹腔镜微创手术治疗IPN临床效果较好,能明显减轻患者炎性损伤,改善免疫功能,缩短住院时间,且术后并发症少,安全性高。 Objective To explore the effect of different timing of laparoscopic minimally invasive surgery on the efficacy of patients with infectious pancreatic necrosis(IPN).Methods A total of 90 IPN patients treated from June 2020 to June 2023 were selected and divided into the early surgery group(days 1-3,n=48)and the late surgery group(days 4-7,n=42)according to the different timing of laparoscopic minimally invasive surgery.The scores of acute physiology and chronic health status scoreⅡ(APACHEⅡ),inflammatory factors and immune function indexes,as well as the incidence of postoperative complications and mortality,were compared between the two groups.Results The duration of surgery,postoperative exhaust time,postoperative diet recovery time and the length of hospital stay in the early surgery group were shorter than those in the late surgery group(P<0.05,P<0.01).All the scores of all dimensions of APACHEⅡwere decreased in the two groups after surgery,which were lower in the early surgery group than in the late surgery group(P<0.05,P<0.01).The levels of neutrophil to lymphocyte ratio,C reactive protein and interleukin-6 in the two groups were decreased after surgery,which were significantly lower in the early surgery group than in the late surgery group(P<0.05,P<0.01).After surgery,the levels of CD3+and CD4+were increased,while the levels of CD8+were decreased in both groups;the levels of CD8+in the early surgery group were significantly lower than those in the late surgery group,while the levels of CD3+and CD4+were significantly higher than those in the late surgery group(P<0.05,P<0.01).The incidence of postoperative complications[27.08%(13/48)]and mortality[2.08%(1/48)]in early surgery group were lower than those in late surgery group[50.00%(21/42)and 14.29%(6/42)](P<0.05).Conclusion Early laparoscopic minimally invasive surgery for IPN has good clinical effects,which can significantly reduce inflammatory injury,improve immune function,shorten the length of hospital stay,and reduce postoperative complications with high safety.

作者赵清涛崔欣汪景洲王宇鹏刘航成 ZHAO Qingtao;CUI Xin;WANG Jingzhou;WANG Yupeng;LIU Hangcheng(Department of Hepatobiliary Pancreatic Spleen,the 980 Hospital of Joint Logistics Support Force of the PLA,Shijiazhuang 050000,China;Department of Neurology,Shenzhen University General Hospital,Shenzhen,Guangdong 518000,China)

机构地区解放军联勤保障部队第九八〇医院肝胆胰脾科深圳大学总医院神经内科

出处《临床误诊误治》 2025年第5期37-41,共5页 Clinical Misdiagnosis & Mistherapy

基金河北省2022年度卫健委医学科学研究课题计划项目(20220241)。

关键词感染性胰腺坏死腹腔镜微创手术手术时机手术时间 C反应蛋白 CD3+ 手术后并发症 Infected pancreatic necrosis Laparoscopic minimally invasive surgery Timing of surgery Duration of surgery C reactive protein CD3+ Postoperative complication

分类号 R576 [医药卫生—消化系统]

作者简介赵清涛,博士研究生,副主任医师。主要从事肝胆脾胰腺及胃肠疾病诊治方向研究;通讯作者:刘航成,E-mail:1090613362@qq.com。