内镜逆行阑尾炎治疗术治疗急性阑尾炎的临床效果

Clinical effect of endoscopic retrograde appendicitis therapy in the treatment of acute appendicitis

摘要:

目的 探讨内镜逆行阑尾炎治疗术对急性阑尾炎患者炎症反应、氧化应激和免疫水平的影响。方法 选择2020年1月－2023年9月在该院治疗的急性阑尾炎患者82例，采用随机数表法分为对照组（41例）和治疗组（41例）。对照组给予腹腔镜阑尾切除术，治疗组给予内镜逆行阑尾炎治疗术，两组患者均观察至出院，并进行1周的随访。比较两组患者手术相关指标、术前和术后24 h炎症因子［血清降钙素原（PCT）、可溶性细胞间黏附分子-1（sICAM-1）、脂氧素A4（LXA4）、可溶性P选择素（sP-s）和C反应蛋白（CRP）］、氧化应激因子［血清超氧化物歧化酶（SOD）和丙二醛（MDA）］及免疫水平［免疫球蛋白M（IgM）和免疫球蛋白G（IgG）］，以及术前、术后12 h和术后24 h的疼痛视觉模拟评分法（VAS）评分和并发症发生情况。结果 与对照组比较，治疗组术中出血量少，术后卧床时间、住院时间、肛门排气时间和术后体温恢复正常时间短，差异均有统计学意义（P < 0.05）；与术前比较，两组患者术后24 h血清sICAM-1、LXA4和sP-s水平降低，血清PCT和CRP水平升高，但治疗组低于对照组，差异均有统计学意义（P < 0.05）；与术前比较，两组患者术后24 h血清SOD、IgM和IgG水平降低，但治疗组高于对照组，与术前比较，两组患者术后24 h血清MDA水平升高，但治疗组低于对照组，差异均有统计学意义（P < 0.05）；与术前比较，两组患者术后12和24 h的疼痛VAS评分呈降低趋势，且治疗组低于对照组，差异均有统计学意义（P < 0.05）；对照组并发症总发生率为26.83%，明显高于治疗组的7.32%，差异有统计学意义（P < 0.05）。结论 采用内镜逆行阑尾炎治疗术治疗急性阑尾炎，能够有效地减轻患者氧化应激反应和炎症反应，保护患者免疫功能，缩短术后恢复时间，缓解疼痛程度，降低术后并发症发生率，值得应用于临床。

Abstract:

Objective To explore the effect of endoscopic retrograde appendicitis therapy on inflammatory reaction, oxidative stress and immune level in patients with acute appendicitis.Methods 82 patients with acute appendicitis who were treated from January 2020 to September 2023, and divided into control group (41 cases) and treatment group (41 cases). The grouping method was random number table method. The control group was given laparoscopic appendectomy, and the treatment group was given endoscopic retrograde appendicitis therapy. Both groups observed that the patients were discharged from hospital and were followed up for 1 week. The operation-related indexes, levels of inflammatory factors [serum procalcitonin (PCT), soluble intercellular adhesion molecule-1 (sICAM-1), lipoxin A4 (LXA4), soluble P-selectin (sP-s) and C-reactive protein (CRP)], oxidative stress [serum superoxide dismutase (SOD) and malondialdehyde (MDA)] and immune function [immunoglobulin M (IgM) and immunoglobulin G (IgG)] before and 24 h after operation, score of pain before operation, 12 h and 24 h after operation and complications (during the study period) were compared between the two groups.Results Compared with the control group, the amount of bleeding in the treatment group was relatively less, and the time of lying on bed, hospitalization, anal exhaust and body temperature returning to normal after operation were relatively shorter, the differences were statistically significant (P < 0.05). Compared with pre-operation, the levels of serum sICAM-1, LXA4 and sP-s in both groups decreased at 24 h after operation, while the level of serum PCT and CRP increased, the treatment group was significantly lower than the control group (P < 0.05). Compared with pre-operation, the levels of serum SOD, IgM and IgG in the two groups decreased at 24 h after operation, but the levels in the treatment group were relatively higher, while the levels of serum MDA all increased, which was lower in the treatment group (P < 0.05). Compared before operation, the scores of pain in the two groups showed a downward trend from 12 and 24 h after operation, and compared with the control group, the scores of pain in the treatment group were relatively lower (P < 0.05). During the study period, compared with 26.83% in the control group, the total incidence of complications in the treatment group was 7.32%, which was relatively lower (P < 0.05).Conclusion Endoscopic retrograde appendicitis therapy for acute appendicitis can effectively reduce patients' oxidative stress and inflammatory reaction, protect their immune function, shorten patients’ postoperative recovery time, relieve their pain and reduce the incidence of postoperative complications.