刘虹辰

【摘要】 目的：探究腹腔镜手术对急性化脓性阑尾炎患儿血清炎症因子和免疫功能的影响。方法：选取2016年3月-2018年3月经治的急性化脓性阑尾炎患儿120例，采用随机数字表法将患儿分为观察组与对照组，各60例。对照组采取开腹阑尾切除术，观察组采取腹腔镜手术治疗。记录两组手术相关指标及术后并发症，检测两组手术前后血清炎症因子及免疫功能变化情况。结果：观察组术中出血量、住院时间及术后首次排气时间均少于对照组（P<0.05）;术后1周，观察组IL-6、IL-8、CRP水平均明显低于对照组，IgM、IgG水平均明显高于对照组（P<0.05）;观察组术后并发症发生率为3.33%，显著低于对照组的15.00%（P<0.05）。结论：腹腔镜手术治疗急性化脓性阑尾炎，能够减少患儿术中出血量，缩短住院时间，降低术后炎症因子的应激表达和免疫功能的损伤，且术后并发症少，安全性高。

【关键词】 腹腔镜手术; 急性化脓性阑尾炎; 炎症因子; 免疫功能

【Abstract】 Objective：To investigate the effects of laparoscopic surgery on serum inflammatory factors and immune function in children with acute suppurative appendicitis.Method：A total of 120 children with acute suppurative appendicitis who underwent surgery from March 2016 to March 2018 were enrolled.The patients were divided into observation group and control group by random number method，with 60 cases in each group.The control group underwent open appendectomy and the observation group underwent laparoscopic surgery.The two groups of surgical related indexes and postoperative complications were recorded.The changes of serum inflammatory factors and immune function before and after operation were detected.Result：The amount of bleeding，length of hospital stay and the first exhaust time of the observation group were lower than those of the control group（P<0.05）.At 1 week after operation，the levels of IL-6，IL-8 and CRP in the observation group were lower than those in the control group，and the levels of IgM and IgG were significantly higher than those in the control group（P<0.05）.The postoperative complication rate was 3.33% in the observation group，which was lower than 15.00% in the control group（P<0.05）.Conclusion：Laparoscopic surgery for acute suppurative appendicitis can reduce the amount of intraoperative blood loss，shorten the length of hospital stay，reduce the stress expression and immune function of postoperative inflammatory factors，and have fewer postoperative complications and high safety.

【Key words】 Laparoscopic surgery; Acute suppurative appendicitis; Inflammatory factors; Immune function

First-authors address：Jiamusi Maternal and Child Health Hospital，Jiamusi 154002，China

doi：10.3969/j.issn.1674-4985.2019.17.032

急性化膿性阑尾炎是外科常见病之一，主要以低热、恶心呕吐、腹痛、腹肌紧张或反跳痛等临床症状为主，多发于儿童和青少年人群[1-2]。相关数据显示，近年来，小儿急性阑尾炎发病率有所增加，占发病人群的10%以上，且发病年龄段以6～12岁儿童为主[3-4]。小儿因阑尾的生理位置较为特殊，是连接盲肠末端的一个类似蚯蚓状的盲管，开口狭窄、系膜短且扭曲，故其管口较易被食物残渣、粪便等堵塞，导致分泌物无法及时排进盲肠，造成细菌于阑尾腔内大量生长、繁殖，穿透管壁而诱发感染[5]。此外，因小儿阑尾的淋巴组织丰富，阑尾管壁薄而肌肉组织少，一旦阑尾感染炎症，淋巴组织会出现严重水肿而引发阑尾腔梗阻，故阑尾穿孔的风险增加，严重威胁患儿生命健康安全[6]。当前，及早将感染阑尾切除是控制感染、降低坏死穿孔等严重并发症发生的关键措施所在。……