两种腹腔镜下保胆取石术对胆囊结石患者炎性因子及T淋巴细胞亚群的影响

目的探讨完全腹腔镜下保胆取石术及腹腔镜辅助保胆取石术两种术式对胆囊结石患者炎性因子和T淋巴细胞亚群的影响。 方法前瞻性选择2016年7月至2017年7月间荆门市第二人民医院行腹腔镜下保胆取石术的胆囊结石患者，依据随机数字表法分为采用腹腔镜辅助保胆取石术的辅助组和采用完全腹腔镜下保胆取石术的完全组，各50例。对比两组患者临床疗效、T淋巴细胞亚群（CD3⁺、CD4⁺和CD8⁺）水平以及炎性因子变化情况。 结果(1)完全组患者的术中出血量（7.6±0.8）ml、手术时间（51.38±0.9）min，显著低于辅助组的（13.5±2.9）ml、（61.27±1.3）min，差异有统计学意义（统计值=44.229、4.651，P=0.016、0.023）。(2)与术前水平比较，两组患者术后1 d时CD3⁺和CD4⁺水平均显著降低，CD8⁺水平显著升高（P<0.05）；术后5 d时辅助组患者CD3⁺和CD4⁺水平虽然有所回升，但仍显著低于术前，CD8⁺水平有所下降，但依旧高于术前（P<0.05）；组间比较，完全组术后1、5 d时CD3⁺和CD4⁺水平均显著高于同期辅助组，CD8⁺水平低于辅助组，差异有统计学意义（P<0.05）。(3)与术前水平比较，术后1 d时两组患者Hs-CRP、IL-6和TNF-α水平均显著增高（P<0.05）；术后5 d时完全组三项指标水平与术前对比差异无统计学意义，而辅助组三项指标虽然有所降低，但仍显著高于术前（P<0.05）。组间比较，术后1、5 d时完全组显著低于同期辅助组，差异均有统计学意义（P<0.05）。 结论完全腹腔镜保胆取石术较辅助腹腔镜保胆取石术治疗效果更好，对患者机体各项炎性因子及T淋巴细胞亚群等指标的影响更小。

Effects of two kinds of laparoscopic cholecystolithotomy on inflammatory factors and T lymphocyte subsets in patients with gallstones

ObjectiveTo investigate the effects of two types of laparoscopic cholecystolithotomy on the inflammatory factors and T lymphocyte subsets in patients with cholecystolithiasis. MethodsA prospective study was conducted, patients enrolled in gallstone from July 2016 to July 2017 in Jingmen Second People’s Hospital who underwent laparoscopic cholelithotomy, as the complete group, and those underwent laparoscopic assisted cholecystolithotomy, as the assisted group, with 50 cases in each group. The level of T lymphocyte subsets (CD3⁺, CD4⁺ and CD8⁺) and the changes of inflammatory factors were compared between the two groups. Results(1) Intraoperative blood loss (7.6±0.8) ml and operative time (51.38±0.9) min in the complete group were significantly lower than those in the assisted group (13.5±2.9) ml, (61.27±1.3) min, the differences were statistically significant (statistical value=44.229, 4.651, P=0.016, 0.023). (2) 1 day after surgery, CD3⁺ and CD4⁺ levels were significantly decreased, CD8⁺ level increased significantly (P<0.05). Postoperative 5 d, CD3⁺ and CD4⁺ levels in assisted group were increased, but still significantly lower than the preoperative level, while CD8⁺ was decreased, but still higher than preoperation (P<0.05). The complete group on postoperative 1 and 5 d, CD3⁺ and CD4⁺ levels were significantly higher than those of the assisted group, but CD8⁺ level lower than the assisted group, the difference was statistically significant (P<0.05). (3) The levels of Hs-CRP, IL-6 and TNF-α on postoperative 1 d in the two groups were significantly increased (P<0.05). 5 d after operation, there was no significant difference of the three indicators compared with preoperation in the complete group, while for the assisted group the three indicators were still higher than preoperation (P<0.05). The complete group was significantly lower than that of the assisted group 1 and 5 d after operation, and the differences were statistically significant (P<0.05). ConclusionLaparoscopic cholelithotomy is more effective than laparoscopic cholecystolithotomy, and has less influence on inflammatory factors and T lymphocyte subsets in patients.