腹腔镜与开腹胆囊切除术对机体免疫功能影响的比较

目的观察及比较腹腔镜和开腹胆囊切除术后血清免疫球蛋白、补体及T淋巴细胞含量的变化情况．研究两者对免疫功能的影响。方法检测60例（LC及OC各30例）胆囊结石患者术前、术后第1天、第5天的外周血淋巴细胞亚群（CD3、CD4、CD8、CD16＋56及CD19）、免疫球蛋白（IgO、IgA、Iga、IgE）及补体C3、C4含量并进行时照研究。结果LC及OC组免疫球蛋白及补体水平均低于术前，两组间差异无显著性（P〉0.05），但OC组血清C3及IgG术后与术前比较差异有显著性（P〈0．05或P〈0．01），且下降幅度与LC组比较差异有显著性（P〈0．01）。OC组术后CD3（总T淋巴细胞）、CD4（辅助／诱导T细胞）较术前明显下降，CD4／CD8较术前也明显下降，术后第5天未能恢复正常，与术前比较差异有显著性（P〈0．05或P〈0．01）。而LC组术后第1天仅轻度下降，术后第5天基本恢复术前水平，两组间差异有显著性（P〈0．01）。结论LC及OC术后早期免疫功能均受到一定程度的抑制，但LC组的免疫功能抑制程度较OC组轻，表明LC时机体的免疫功能影响比OC小。

Influence of laparoscopic cholecystectomy and open surgery on immune function

Objective] Investigation and comparison changeable condition of laparoscopic cholecystectomy and open cholecystectomy on the immunoglobullins, complements and T lymphoxyte. To study the Influence of laparoscopic cholecystectomy and open cholecystectomy on immune system. Method] We selected 60 chronic cholecystitis patients. Laparoscopic cholecystectomy and open cholecystectomywere 30 patients. Blood samples were obtained at study entry with preoperation and at day 1, 5 postoperation. Serum was prepared to examine immunoglobullins (IgG, IgA, IgE, IgM), complement (C3, C4) and T lymphocyte(CD, CD4, CD8, CD16+56, CD19). Result] Postoperative levels of serum immunoglobulins and complements of laparoscopic cholecystectomy and open cholecystectomy were lower than preoperative levels. The difference was not statistically significant (P >0.05). But the level of serum C3 and IgG were significantly decreased after open cholecystectomy, the difference was statistically significant(P <0.05 or P <0.01). The levels of serum C3 and IgG after open cholecystectom more significantly decreased than laparoscopic cholecystectomy, the difference was statistically significant (P <0.05 or P <0.01). The level of serum CD3, CD4 and CD4/CD8 were significantly decreased after open cholecystectomy, But postoperative levels of serum CD3, CD4, CD8, CD16+56, CD19 and CD4/CD8 of laparoscopic cholecystectomy were little decreased than preoperation, and recovered basically normal to 5 days after operation, the difference was not statistically significant (P >0.05). The differences of two groups were statistically significant (P <0.01). Conclusion] Both laparoscopic cholecystectomy and open cholecystectomy conld cause a certain degree depression of immune function in the earlier postoperative period. But laparoscopic cholecystectomy caused less depression of immune function than open cholecystectomy did and recovery of the immunosuppression in laparoscopic cholecystectomy was more quickly than in open cholecystectomy. That was to say, laparoscopy procedure was less traumatic.