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1.
目的:比较腹腔镜与开腹胃大部切除术对机体免疫功能的影响。方法:选择40例有胃大部切除指征的患者,分为腹腔镜组和开腹组,各20例,测定免疫球蛋白IgG、IgM、IgA,补体C3、C4水平及测定、组间比较CD3+(T细胞总数)、CD4+(T辅助/诱导细胞)、CD8+(T抑制/杀伤细胞)的数量。结果:两组IgM、IgA、C4手术前后均无明显变化,组间无统计学差异。腹腔镜组术后1d IgG、C3较术前有所下降,术后3d恢复至术前水平。开腹组IgG、C3术后1d明显低于术前水平,术后5d恢复至术前水平。腹腔镜组淋巴细胞亚群手术前后均无统计学差异,开腹组术后1d CD3+、CD4+、CD8+与术前比较均明显降低,术后5d恢复至术前水平。结论:腹腔镜对机体免疫功能的影响小,术后恢复较快。  相似文献   

2.
腹腔镜胆囊切除术对机体免疫功能的影响   总被引:6,自引:0,他引:6  
目的:比较腹腔镜与开腹胆囊切除术对机体免疫功能的影响。方法:随机将有胆囊切除手术指征的80例患者分为2组,腹腔镜胆囊切除组(laparoscopic cholecystectomy,LC组)和开腹胆囊切除组(open cholecystectomy,OC组)各40例,测定并比较手术前后IgG、IgM、IgA,补体C3、C4水平及CD3^+(T细胞总数)、CD4^+(T辅助/诱导细胞)和CD8^+的数量。结果:两组IgM、IgA、C4手术前后均无明显变化,两组间差异无统计学意义。LC组术后1d IgG、C3较术前有所下降,术后3d恢复至术前水平;OC组术后1d IgG、C3明显低于术前水平,术后5d恢复至术前水平;组间比较,OC组术后IgG、C3下降明显。LC组T淋巴细胞亚群手术前后差异无统计学意义,OC组术后1d CD3^+、CD4^+、CD8^+与术前比较明显降低,术后5d恢复至术前水平;组间比较,术后1d、3d OC组CD3^+、CD4^+、CD8^+均明显低于LC组。结论:腹腔镜手术对机体的免疫功能影响小,术后恢复快。  相似文献   

3.
目的:比较腹腔镜手术与传统开腹手术对患者免疫机能的影响。方法:2006年12月至2007年7月收治结直肠癌患者60例,分别行腹腔镜手术和开腹手术各30例,于术前1d和术后第3天、第7天抽取外周静脉血,比较两组患者的C反应蛋白,IgA,IgM,IgG,IL-6,CD3+,CD4+,CD8+细胞和NK细胞,比较术前1d和术后第1天、第3天TNF-α细胞活性。结果:术后第3天患者CD3+,CD4+,CD8+细胞活性及CD4+/CD8+差异无显著性,但术后第7天腹腔镜较开腹组明显低。术后第3天IL-6开腹组明显高于腹腔镜组。C反应蛋白于术后第3天开腹组高于腹腔镜组。IgM于术后第3天开腹组高于腹腔镜组,IgA、IgG无显著统计学意义。TNF-α于术后第3天开腹组高于腹腔镜组。结论:腹腔镜结直肠癌根治术较传统开腹手术对机体免疫机能影响较小。  相似文献   

4.
腹腔镜结直肠癌根治对机体免疫状态的影响   总被引:18,自引:0,他引:18  
目的探讨腹腔镜手术治疗结直肠癌对机体免疫状态的影响。方法2004年3月至2004年12月,同一手术组将可手术治疗的结直肠癌患者60例,随机分为腹腔镜手术组和开放手术组,每组各30例。分别在术前1d和术后3、7d取外周静脉血,测定C反应蛋白(CRP)、免疫球蛋白(Ig)A、IgM、IgG,CD3+、CD4+、CD8+、自然杀伤细胞(NK细胞)和CD4+CD45RA+、CD4+CD45RO+细胞及血淋巴细胞数并进行比较。结果开放手术组术后3d外周血淋巴细胞数(1.09±0.29)×109/L,CD4+细胞(0.54±0.14)×109/L,CD8+细胞(0.31±0.08)×109/L,CD4+CD45RO+细胞(61.1±8.9)%,IgM(136.9±52.8)IU/ml,IgG(115.2±45.7)IU/ml;术后7dCD8+细胞(0.32±0.09)×109/L,CD4+CD45RO+细胞(63.2±9.1)%,均明显低于术前(P<0.05,P<0.01)。而腹腔镜手术组术后3d除CD4+CD45RO+细胞犤(62.7±12.5)%犦较术前降低(P<0.05)外,其余免疫学指标无明显降低;而淋巴细胞数犤(1.29±0.37)×109/L犦、IgM犤(164.5±48.2)IU/ml犦和CD8+细胞数犤(0.38±0.09)×109/L犦与开放手术组比较,差异有统计学意义(P<0.05)。结论腹腔镜手术治疗结直肠癌比开放手术在免疫功能保护上更具有优势。  相似文献   

5.
腹腔镜与开腹结直肠癌手术对机体免疫功能的比较   总被引:10,自引:0,他引:10       下载免费PDF全文
为比较腹腔镜和开腹结直肠癌根治术对机体免疫功能的影响,笔者将2年间收治的60 例结直肠癌患者随机分为腹腔镜组和开腹组,各30例 。由同一手术组对60例患者实施手术。分别于术前1d的和术后第3天及第1,2 周取外周静脉血,测定C反应蛋白(CRP),IL-6,免疫球蛋白IgA,IgM,IgG, CD3+ ,CD4+,CD8+及NK细胞活性;对两组细胞活性进行比较。结果示,术后第3 天,两组患者外周血CD3+ ,CD4 +,CD4+/ CD8+及NK 细胞活性差异无显著性 (P>0.05) ;但于术后第1,2 周开腹组显著低于腹腔镜组 (P<0.01) 。术后第3 天,开腹组IL-6明显高于腹腔镜组(P<0.01)。术后第3,7d,开腹组CRP明显高于腹腔镜组(P<0.01,P<0.05)。术后第3天腹腔镜组IgM高于开腹组(P<0.05);IgA,IgG两组间无统计学差异(P>0.05)。提示腹腔镜结直肠癌根治术比传统开腹手术对机体影响小,对保护患者免疫功能具有优势。  相似文献   

6.
目的:腹腔镜辅助下与开腹行进展期胃癌根治术对机体免疫功能的影响.方法:将94例进展期胃癌患者按意愿分为腹腔镜组(n=47)与开腹组(n=47),测定2组术前及术后第3、7、14天患者血清IL-6、CRP、IgG、IgM、IgA、CD3+、CD4+,CD8+,CD4+/CD8+、人类白细胞抗原Ⅱ型(HLA-DR)、中性粒细胞(PMN)的数量.结果:2组术后第3天免疫球蛋白较术前均降低(P<0.05),开腹组术后第7天免疫球蛋白较术前低(P<0.05),腹腔镜组术后第7天免疫球蛋白较术前比较差异无统计学意义(P>0.05),除术后第3、7天IgM腹腔镜组高于开腹组(P<0.05),2组间IgA、IgG术后差异无统计学意义(P>0.05);2组术后第3、7天2组IL-6、CRP较术前明显升高(P<0.01),开腹组升高较腹腔镜组更明显(P<0.01);术后第3、7、14天腹腔镜组HLA-DR较术前明显升高(P<0.01),2组间差异有统计学意义(P<0.01,表5);2组术后第3天PMN较术前明显升高(P<0.01);2组外周血CD3+、CD4+,CD4+/CD8+术后第7、14天较术前均明显下降(P<0.01),术后腹腔镜组明显高于开腹组(P<0.01),且腹腔镜组较早恢复正常.结论:与开腹手术相比,腹腔镜手术对机体术后的免疫功能影响小,术后恢复快.  相似文献   

7.
目的 探讨腹腔镜手术治疗子宫内膜癌的临床效果.方法 将1998年8月~2004年12月术前确诊为子宫内膜癌的患者60例分为2组,分别施以腹腔镜下及腹式广泛子宫切除,术中根据子宫肌层受侵情况决定是否行盆腔淋巴结清扫术,前瞻性研究两组围手术期及生存情况.结果 与开腹组比较,腹腔镜组手术时间长[(247.8±77.8)min vs(196.6±63.7)min,t=2.789,P=0.007],术中出血量相近[(265.0±187.6)ml vs(350.0±210.9)ml,t=-1.649,P=0.104],切除盆腔淋巴结数量相近[(22.0±5.0)个vs(22.8±5.2)个,t=-0.607,P=0.546],术后并发症发生率差异无显著性(10/30 vs15/30,χ2=1.714,P=0.190),术后肛门排气时间早[(44.3±11.1)min vs(55.2±12.8)min,t=-3.524,P=0.000],住院时间短[(8.7±3.2)d vs(10.2±2.0)d,t=-2.177,P=0.034].腹腔镜组随访(28.6±17.4)月,均无瘤存活;开腹组随访(28.9±16.6)月,3例因转移或复发死亡.结论 腹腔镜手术可达到与开腹手术一样的效果,可以作为治疗子宫内膜癌的术式之一,但应在有条件的医院逐步开展.  相似文献   

8.
目的 观察腹腔镜巨脾切除术对患者免疫功能的影响.方法 将26例巨脾、脾功能亢进患者随机分为腹腔镜巨脾切除组(LS)12例和开腹脾切除组(OS)14例,比较两组病例术前、术后1、7 d外周血淋巴细胞亚群及免疫球蛋白变化.结果 腹腔镜组术后1、7 d的成熟T淋巴细胞(CD3)、辅助T淋巴细胞(CD4)、CD4与抑制淋巴细胞(CD8)的比值及免疫球蛋白IgG、IgA、IgM与术前比较差异无统计学意义(P>0.05).开腹组术后1、7 d的CD3、CD4、CD4/CD8及IgG与术前比较明显下降(P<0.05).结论 腹腔镜巨脾切除术较开放脾切除术对患者免疫抑制程度轻.  相似文献   

9.
腹腔镜结直肠癌手术对机体影响的探讨   总被引:4,自引:0,他引:4  
目的探讨腹腔镜下结直肠癌手术的低侵袭性。方法将符合纳入研究对象标准的40例结直肠癌患者随机分成腹腔镜组(20例)和开腹组(20例),比较两组患者围手术期(术前、术后当天、术后第1、3、5d)的外周血白介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)、可溶性细胞间黏附分子(sICAM-1)、白细胞CD11b的变化。结果开腹组术后细胞因子(TNF-α、IL-6、IL-8)明显高于腹腔镜组(P<0.05)。开腹组术后6h、第1天时,sICAM-1的动态变化较腹腔镜组显著升高,开腹组外周血白细胞CD11b在术后6h降至最低(161.98±48.42),较腹腔镜组(189.51±46.45)明显低(P<0.05)。结论结直肠癌的腹腔镜手术比传统开腹手术对机体影响小,具有明显的低侵袭性。  相似文献   

10.
目的 比较腹腔镜与开腹手术对70岁以上老年结直肠癌患者的近期疗效,并评价腹腔镜手术的安全性和可行性.方法 回顾分析2009年1月-2015年12月仪征市人民医院普外科收治的91例行腹腔镜与开腹手术的70岁以上老年结直肠癌患者的临床资料,其中腹腔镜组38例,开腹组53例.比较两组的手术学指标、术后恢复及并发症发生情况等.数据比较采用t检验、Mann-WhitneyU检验、Pearson x2检验或Fisher确切概率检验.结果 两组患者的年龄、性别、ASA评分、既往腹部手术史、病理分期及慢性合并症构成差异无统计学意义.两组均无死亡病例.腹腔镜组38例,1例(2.1%)因右侧输尿管损伤中转开腹行输尿管修补吻合+双“J”管置入术,传统开腹组53例.腹腔镜组和开腹组手术时间(238 ±71.3) minvs(175±60.8) min、术中出血量(145 ±58) ml vs (186 ±45) ml比较,差异均具有统计学意义(P<0.05).淋巴结清扫数目(11.6±2.8)枚vs(13.1±3.0)枚,P=0.513,差异无统计学意义,所有标本切缘病理检查均为阴性.腹腔镜组术后首次下床活动时间(2.1±1.7)dvs(2.9±0.8)d、肠功能恢复时间(3.6±0.5)dvs(4.1±0.6)d、进食流质时间(3.3±0.3)dvs(3.9±0.6)d、术后住院时间(11.9±3.9) dvs (14.5±3.7)d,均显著低于开腹组(P<0.05).术后总并发症23.7%,显著低于开腹组45.3% (P =0.035);切口感染也显著降低(P=0.017).术中并发症以及术后吻合口瘘、吻合口出血、尿路感染、肺部感染、腹腔感染、肠梗阻、淋巴漏、心律失常、谵妄发病率两组差异均无统计学意义(P>0.05).结论 老年结直肠癌患者实施腹腔镜手术是安全可行的,近期疗效优于开腹手术.  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

13.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

14.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

15.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

16.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

17.
Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg?1 i. v. and 32 μg · kg?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg?1. The mean ED50s, calculated from dose-response curves, were 5.4 mg · kg?1, 3.9 μg · kg?1 and 0.4 mg · kg?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg?1 and 8 μg · kg?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.  相似文献   

18.
Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg?1 · min?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min?1 · m?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.  相似文献   

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Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.  相似文献   

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