许宇彪　李碧锦　何二松

【摘要】 目的：比较腹腔镜与开腹修补术治疗老年上消化道穿孔的临床效果及对免疫功能的影响。方法：分析81例在本院行胃十二指肠溃疡穿孔修补术老年患者的临床资料，其中腹腔镜组42例，开腹组39例，比较两组手术时间、肛门排气时间、住院时间、死亡率、术后VAS疼痛评分、术后镇痛剂使用率及常见并发症发生率，于术前和术后第1、3、5、7天测定两组患者外周血CD3+、CD4+、CD8+T細胞和外周血CRP、IL-6、TNF-α。结果：腹腔镜组肛门排气时间、住院时间均显著低于开腹组，腹腔镜组术后第1、3、5、7天VAS评分及术后镇痛剂使用率显著低于对照组，腹腔镜组并发症发生率明显低于开腹组，差异均有统计学意义（P<0.05）。术后第1、3天两组CD3+、CD4+、CD8+T细胞比较，差异均无统计学意义（P>0.05），第5、7天腹腔镜组CD3+、CD4+、CD8+T细胞均显著高于开腹组（P<0.05）。腹腔镜组术后同一时点CRP、IL-6、TNF-α均显著低于开腹组（P<0.05）。结论：腹腔镜穿孔修补术治疗老年上消化道穿孔效果较开腹好，对细胞免疫功能影响小，应激反应小，微创优势明显，可作为临床首选方案。

【关键词】 腹腔镜； 胃肠穿孔修补术； 老年患者； 上消化道穿孔

【Abstract】 Objective：To compare the clinical effect of laparoscopic and open gastrointestinal perforation repair in the treatment of elderly patients with upper digestive tract perforation and to investigate their effect on immune function.Method：A total of 81 cases suffering from gastric and duodenal perforation were enrolled to undergo repair of gastrointestinal perforation，including the laparoscopic group（n=42） and the open surgery group（n=39）.The clinical data including operation time，anal exhaust time，hospitalization time，mortality，postoperative VAS pain score，postoperative analgesic agents use rate and incidence of complication were analysed.And the index including preoperative and postoperative 1，3，5，7 days outside week blood CD3+，CD4+，CD8+ T cells and serum CRP，IL-6，TNF-αof two groups were detected.Result：The anal exhaust time，hospitalization time of the laparoscopic group were significantly lower than those of the open surgery group（P<0.05）.VAS score postoperative 1，3，5，7 days and postoperative analgesic usage were significantly lower than those of the open surgery group（P<0.05）.The incidence of complication of the laparoscopic group was obviously lower than that of the open surgery group.The significant difference had been showed up.The outside week blood CD3+，CD4+，CD8+T cells postoperative 1，3 days in two group existed no significant difference，and CD3+，CD4+ and CD8+ T cells postoperative 5，7 days in the laparoscopic group were significantly higher than those of the open surgery group.Postoperative CRP，IL-6 and TNF-α of the laparoscopic group were significantly lower than those of the open surgery group at the same time point（P<0.05）.Conclusion：Laparoscopic repair of gastrointestinal perforation can reduce stress response，and its effect on cellular immune function is little，therefore，laparoscopic repair of gastrointestinal perforation in the treatment of elderly patients with upper digestive tract perforation is better than open surgery.Owing to its obvious minimally invasive advantage，it is available as a first choice in the clinical field.

【Key words】 Laparoscopic； Repair of gastrointestinal perforation； Elderly patients； Upper digestive tract perforation

First-authors address：Jiangbin Hospital of Guangxi Zhuang Autonomous Region，Nanning 530021，China

doi：10.3969/j.issn.1674-4985.2016.32.008

腹腔镜微创手术具有创伤小、术后恢复快等优点，但是老年患者具有特殊的心理生理特点，老年上消化道穿孔患者能否当然的获益于腹腔镜穿孔修补术，尚需进一步研究。本研究通过对比分析老年上消化道穿孔患者行腹腔镜下胃肠穿孔修补术和开腹胃肠穿孔修补术的临床效果以及术后免疫功能的变化，为评价老年患者腹腔镜下胃肠穿孔修补术的微创优势提供客观依据，现报道如下。

1 资料与方法

1.1 一般资料 回顾性分析2010年1月-2014年7月广西壮族自治区江滨医院普通外科行胃十二指肠溃疡穿孔修补术的老年患者的临床资料，入选标准：年龄≥65岁，行开腹或腹腔镜穿孔修补术。……