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目的比较腹腔镜与开腹胆囊切除术对机体急性炎症应激(SIRS)反应的影响。方法将2007年3月至2009年10月间我院130例行胆囊切除术患者随机纳入腹腔镜胆囊手术组(70例)及开腹对照组(60例),所有手术均由同一手术小组固定成员实施。比较两组患者手术前后白细胞总数、中性粒细胞百分数的变化以及CRP急性期蛋白的改变,同时比较两组患者术后7d期间SIRS发生的情况。结果两组间术后白细胞总数(WBC)及中胜粒细胞百分数(NE%)比较无统计学差异(P>0.05)。术后1、3、5d开腹组CRP表达更高(P<0.05)。术后1、5d开腹组的SIRS发生率高于腹腔镜组,而且术后1～7d期间开腹组患者发生SIRS持续时间高于腹腔镜组(P<0.05)。结论腹腔镜组术后CRP急性蛋白表达都较开腹组低,提示腹腔镜组术后炎症应激更轻。腹腔镜胆囊组手术造成机体的氧化应激反应虽然较开腹组明显,但术后消退也较开腹组快,未对机体产生明显不良影响。
Objective To compare the effects of laparoscopic and open cholecystectomy on the acute inflammatory response (SIRS) in the body. Methods From March 2007 to October 2009, 130 patients undergoing cholecystectomy in our hospital were randomly divided into laparoscopic cholecystectomy group (70 cases) and open control group (60 cases). All operations were performed by the same operation team Member implementation. The total number of leukocytes, the percentage of neutrophils and the protein of acute phase of CRP in both groups were compared before and after surgery. The occurrence of SIRS in the two groups was compared between the two groups. Results There was no significant difference in WBC and NE% between two groups (P> 0.05). The CRP expression in the open group was higher at 1, 3, 5 days after operation (P <0.05). The incidence of SIRS in the laparotomy group was higher than that in the laparoscopic group on the 1st and 5th day after laparotomy, and the duration of SIRS in the laparotomy group was higher than that in the laparoscopic group (P <0.05). Conclusions The expression of CRP in laparoscopic group is lower than that in open group, which suggests that laparoscopic group has less inflammatory stress. Laparoscopic gallbladder surgery caused by the body’s oxidative stress response although more obvious than the open group, but postoperative resolution is also faster than the open group, did not produce significant adverse effects on the body.