Peng Huaidu, Zhang Junshuo, Cai Chudong, Fang Xi, Wu Junwei
1 Department of General Surgery, Shantou Central Hospital and The Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, China.
Surg Innov. 2018 Feb;25(1):7-15. doi: 10.1177/1553350617739424. Epub 2017 Nov 3.
To explore the influence of carbon dioxide pneumoperitoneum (CDP) on system inflammatory response syndrome (SIRS) and bacterial translocation (BT) in patients with bacterial peritonitis (BP) caused by acute appendicitis (AA).
Eighty-six consecutive subjects were randomly divided into the laparoscopy and laparotomy groups (n = 44 and n = 42, respectively). The levels of white blood cells (WBC), C-reactive protein (CRP), tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6) of the 2 groups were tested preoperatively and at days 1, 2, and 4 after surgery. Blood and secretion culture was performed to verify whether septicemia or incision infection occurred, respectively. And the abdominal ultrasound or computed tomography scanning was used to diagnose peritoneal abscess for the suspected patients. The essential risk factors related to the aggravation of SIRS were analyzed through analysis of variance and binary logistic regression.
The postoperative blood levels of WBC, CRP, TNF-α, and IL-6 on day 4 in the laparoscopy group were significantly lower than those in the control group (all Ps < .05). The differences in incidence rates of septicemia and peritoneal abscess between the CDP and control groups were not statistically significant ( P > .05). Nevertheless, the incision infection rate in the laparoscopy group was apparently lower than that in the control group (4.55% vs 19.04%, P = .047). Analysis of variance and binary logistic regression showed that the non-pneumoperitoneum, pathological type of appendicitis, and multidrug resistant infections were the 3 major risk factors for SIRS (the P values were .001, .019, and .012, respectively).
It was found that CDP is safe for BP and could be a potential protective factor to mitigate BP effectively, indicating that the performance of laparoscopy operation under CDP is feasible to control SIRS; at the same time, CDP would not raise the incidence rate of BT.
探讨二氧化碳气腹（CDP）对急性阑尾炎（AA）所致细菌性腹膜炎（BP）患者全身炎症反应综合征（SIRS）及细菌易位（BT）的影响。
将86例连续入选的受试者随机分为腹腔镜组和开腹组（分别为n = 44和n = 42）。检测两组患者术前及术后第1、2和4天的白细胞（WBC）、C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）和白细胞介素6（IL-6）水平。分别进行血培养和分泌物培养以验证是否发生败血症或切口感染。对于疑似患者，采用腹部超声或计算机断层扫描诊断腹腔脓肿。通过方差分析和二元逻辑回归分析与SIRS加重相关的主要危险因素。
腹腔镜组术后第4天的WBC、CRP、TNF-α和IL-6血水平显著低于对照组（所有P值<0.05）。CDP组与对照组之间败血症和腹腔脓肿的发生率差异无统计学意义（P>0.05）。然而，腹腔镜组的切口感染率明显低于对照组（4.55%对19.04%，P = 0.047）。方差分析和二元逻辑回归显示，非气腹、阑尾炎病理类型和多重耐药感染是SIRS的3个主要危险因素（P值分别为0.001、0.019和0.012）。
发现CDP对BP是安全的，并且可能是有效减轻BP的潜在保护因素，表明在CDP下进行腹腔镜手术对控制SIRS是可行的；同时，CDP不会提高BT的发生率。
