腹腔镜与开腹手术治疗穿孔性阑尾炎患儿的临床疗效及对血清CRP和PCT水平的影响比较

目的:分析和比较腹腔镜阑尾切除术(LA)与开腹阑尾切除术(OA)治疗穿孔性阑尾炎患儿的临床效果及对患儿血清C反应蛋白(CRP)、降钙素原(PCT)水平的影响。方法:选取我院2013年1月～2016年12月收治的98例穿孔性阑尾炎患儿,依据随机数字表法均分为两组。对照组行OA治疗,观察组行LA治疗。记录比较两组患儿切口长度、术中出血量、手术时间、术后排气时间及住院时间等手术情况;术后镇痛药物使用及并发症情况;围术期各时点血清CRP、PCT水平。结果:两组患儿均成功完成手术,观察组患儿中无中转开腹者。观察组患儿的切口长度、术中出血量、手术时间、术后排气时间及住院时间均显著优于对照组(P0.01)。观察组患儿术后镇痛药物使用率及并发症率均为4.1%,均明显低于对照组的16.3%、18.4%(P0.05)。两组术前12 h时血清CRP、PCT水平比较差异均无统计学意义(P0.05);与术前12 h时相比,两组术后24、48 h时血清CRP、PCT水平均显著升高(P0.01);两组术后48 h时血清CRP、PCT水平较术后24 h时均显著降低(P0.01);与对照组同期对比,观察组术后24、48 h时血清CRP、PCT水平均显著降低(P0.01)。结论:与开腹手术相比,腹腔镜手术治疗穿孔性阑尾炎患儿具有创伤小、手术时间短、术后并发症少等优势,能更有效降低血清CRP、PCT水平,促进患儿术后恢复。

Comparison of the Clinical Effect of Laparoscopic Appendectomy and Open Appendectomy on Children with Perforated Appendicitis and the Impact on the Serum CRP and PCT Levels

ABSTRACT Objective: To explore the clinical effect of laparoscopic appendectomy (LA) and open appendectomy (OA) on the children with perforated appendicitis and impact on the serum C reactive protein (CRP) and procalcitonin (PCT) levels. Methods: 98 cases of children with perforated appendicitis admitted in our hospital from January 2013 to December 2016 were selected and randomly divid- ed into two groups. OA was provided to the control group while LA was provided to the observation group. The surgical conditions in- cluding incision length, intraoperative blood loss, operation time, postoperative ventilation time and hospital stay; postoperative analgesic drug use and complications; serum CRP, PCT levels before and after operation were compared between two groups. Results: All the chil- dren in both groups successfully finished the surgery; no kid in observation group transferred to open appendectomy. The incision length, intraoperative blood loss, operation time, postoperative ventilation time and hospital stay of observation group were significantly better than those of the control group (P<0.01). The percentage of postoperative analgesic drug use and incidence of complications were both 4.1% in the observation group, which were significantly lower than those of the control group(16.3%, 18.4%, P<0.05). No statistical dif- ference was found in the serum CRP, PCT levels between two groups at 12th preoperation (P>0.05). The serum CRP, PCT levels at 24th and 48th postoperation were higher in both groups than those at 12th preoperation (P<0.01). The serum CRP, PCT levels at 48th postopera- tion were significantly lower than those at 24th postoperation(P<0.01). The serum CRP, PCT levels of observation group at 24th, 48th post- operation were significantly lower than those of the control group at same time points(P<0.01). Conclusion: Compared with open appen- dectomy, laparoscopic appendectomy caused less trauma, shorter operative time, less postoperative complications and other minimally in- vasive advantages on children with perforated appendicitis. LA could more effectively decrease the serum CRP, PCT levels and promote the postoperative recovery.