频谱照射联合腹腔镜手术对阑尾炎患儿炎症反应和免疫功能的影响

Impact of spectrum irradiation combined with operative laparoscopy on inflammatory reaction and immune function in children with appendicitis

摘要:

目的 研究频谱照射联合腹腔镜手术对阑尾炎患儿炎症反应和免疫功能的影响。方法 选取该科2022年1月－2023年1月收治的小儿阑尾炎患儿120例作为研究对象，使用随机数表法分为对照组（n = 60）和研究组（n = 60）。对照组行腹腔镜下微创阑尾切除术治疗，研究组行频谱照射联合腹腔镜下微创阑尾切除术治疗。比较两组患儿围手术期恢复状况、血清降钙素原（PCT）、C反应蛋白（CRP）水平、细胞免疫功能（CD4⁺、CD8⁺和CD4⁺/CD8⁺）、体液免疫功能［免疫球蛋白M（IgM）、免疫球蛋白G（IgG）、补体C3和C4］、疼痛视觉模拟评分法（VAS）、Alvarado评分、治疗效果和术后并发症发生率。结果 与对照组比较，研究组术后首次肛门排气时间和住院时间明显缩短，差异均有统计学意义（P < 0.05）。与术前比较，两组患儿术后12和24 h的PCT和CRP水平升高，以术后12 h最高；研究组术后12和24 h的PCT和CRP水平较对照组低，差异均有统计学意义（P < 0.05）。与术前比较，两组患儿术后12和24 h的CD4⁺、CD8⁺和CD4⁺/CD8⁺降低，以术后12 h最低；研究组术后12和24 h的CD4⁺、CD8⁺和CD4⁺/CD8⁺较对照组高，差异均有统计学意义（P < 0.05）。与术前比较，两组患儿术后IgM、IgG、C3和C4水平降低，以术后12 h最低；研究组术后12和24 h的IgM、IgG、C3和C4水平较对照组高，差异均有统计学意义（P < 0.05）。与术前比较，两组患儿术后12和24 h VAS和Alvarado评分降低；研究组术后12和24 h的VAS和Alvarado评分较对照组低，差异均有统计学意义（P < 0.05）。与对照组比较，研究组总有效率高，并发症总发生率低，差异均有统计学意义（P < 0.05）。结论 频谱照射联合腹腔镜手术，可减轻阑尾炎患儿术后炎症反应，提高免疫功能，缩短炎症反应时间和免疫抑制时间，减轻患者疼痛，降低术后并发生发生率，临床疗效好。值得临床应用。

Abstract:

Objective To study the effect of spectrum irradiation combined with operative laparoscopy on inflammatory reaction and immune function in children with appendicitis.Methods 120 children with appendicitis from January 2022 to January 2023 were selected as the study subjects, randomly divided them into two groups using a random number table method: the control group (n = 60) and the study group (n = 60). The control group underwent laparoscopic minimally invasive appendectomy, and the study group underwent spectrum irradiation combined with laparoscopic minimally invasive appendectomy. The two groups compared perioperative recovery, procalcitonin (PCT), C-reactive protein (CRP) level, cellular immune function (CD4⁺, CD8⁺, and CD4⁺/CD8⁺), humoral immune function [immunoglobulin M (IgM), immunoglobulin G (IgG), C3, and C4], pain visual analogue scale (VAS), Alvarado score, and treatment effect and postoperative complication rate.Results Compared with the control group, the study group showed a significant reduction in the time to first anal exhaust and hospital stay after surgery, the differences were statistically significant (P < 0.05). Compared with preoperative levels, the levels of PCT and CRP in both groups of patients increased at 12 and 24 h postoperatively, with the highest levels occurring at 12 h postoperatively; The PCT and CRP levels in the study group were lower than those in the control group at 12 and 24 h after surgery, the differences were statistically significant (P < 0.05). Compared with preoperative data, the CD4⁺, CD8⁺, and CD4⁺/CD8⁺ levels decreased in both groups at 12 and 24 h postoperatively, with the lowest levels observed at 12 h postoperatively; The CD4⁺, CD8⁺, and CD4⁺/CD8⁺ levels in the study group were higher than those in the control group at 12 and 24 h after surgery, the differences were statistically significant (P < 0.05). Compared with preoperative levels, the levels of IgM, IgG, C3, and C4 in both groups of patients decreased after surgery, with the lowest levels occurring 12 h after surgery; The levels of IgM, IgG, C3, and C4 in the study group were higher than those in the control group at 12 and 24 h after surgery, the differences were statistically significant (P < 0.05). Compared with preoperative conditions, the VAS and Alvarado scores in both groups of patients decreased at 12 and 24 h after surgery. The VAS and Alvarado scores of the study group were lower than those of the control group at 12 and 24 h after surgery, the differences were statistically significant (P < 0.05). Compared with the control group, the study group had a higher overall effective rate and a lower total incidence of complications, the differences were statistically significant (P < 0.05).Conclusion Spectrum irradiation combined with operative laparoscopy can reduce postoperative inflammatory reaction, and improve immune function in children with appendicitis, shorten inflammatory reaction and immunosuppression time, reduce pain, and have a low incidence of postoperative complications, with ideal effect.