比较 EST 与开腹取石对胆总管结石患者机体炎症反应和免疫功能的影响

目的：探讨内镜下乳头括约肌切开取石术（ EST）与开腹取石对胆总管结石患者机体炎症反应和免疫功能的影响。方法选择该院2009年4月至2013年10月胆总管结石患者160例，其中行EST患者80例，行开腹手术患者80例，比较两组患者围手术期炎性反应指标：降钙素原（PCT）、C反应蛋白（CRP）、IL-6及免疫功能指标：免疫球蛋白（IgA、IgG、IgM）及T淋巴细胞亚群（CD4、CD8、CD4／CD8）的变化。结果开腹组和EST组的IL-6、PCT和CRP术前水平差异无统计学意义（P＞0．05），术后1、3 d EST组的IL-6、CRP、PCT水平均高于开腹组（ P＜0．05），术后5 d两组的IL-6、CRP、PCT水平无统计学差异（ P＞0．05）。开腹组和EST组的IgG、IgA、IgM术前水平差异无统计学意义（P＞0．05），术后1、3、5 d EST组的IgG、IgA、IgM水平明显高于开腹组（ P＜0．05）。两组患者术前CD3＋、CD4＋、CD4＋／CD8＋，差异无统计学意义（ P＞0．05）；术后1 d传统开腹组术后的CD4＋、CD4＋／CD8＋水平低于EST组（ P＜0．05），CD3＋水平差异无统计学意义（ P＞0．05）；术后3、5 d传统开腹组的CD3＋、CD4＋、CD4＋／CD8＋水平明显低于EST组（P＜0．05）。结论与开腹手术治疗胆总管结石相比，EST对机体组织损伤小、免疫抑制轻，虽短时间内出现炎症反应增强，但经过对症治疗，对于患者生理和免疫功能恢复无明显影响。同时EST操作简便、创伤小、手术时间短、并发症少且疼痛轻微，可广泛应用于临床。

Impact of endoscopic sphincterotomy and bile duct exploration with open surgery on inflammatory response and immune function

Objective To evaluate the impact of endoscopic sphincterotomy ( EST) and bile duct exploration with open surgery on in-flammatory response and immune function.Methods 160 patients with choledocholithiasis were divided into endoscopy group ( n=80) and laparotomy group (n=80) from April 2009 to October 2013.Procalcitonin (PCT), C-reactive protein (CRP), IL-6, immu-noglobulins ( IgA, IgG, IgM) and T lymphocyte ( CD3 +, CD4 +, CD4 +/CD8 +) of peripheral blood were examined preoperatively, and on the 1st, 3rd and 5th day postoperatively as well.Results Comparing the preoperative levels of serum IL-6, PCT and CRP in both groups, there was no significant difference between them (P>0.05).The changes of IL-6, CRP and PCT levels on the 1st and 3rd dayafter the operation in the EST group were higher than the laparotomy group (P<0.05).There was no significant difference in the levels of IL-6, CRP and PCT on the 5th day after operation in both groups (P>0.05).Comparing the preoperative levels of IgG, IgA and IgM levels in both groups, no significant difference was observed between them (P>0.05).Postoperative levels of the IgG, IgA and IgM levels in EST were significantly higher than those in the laparotomy group (P<0.05).Comparing the preoperative levels of CD3 +、CD4 +、CD4+/CD8 +ratio in both groups, the difference was not statistically significant (P>0.05).The postoperative levels of CD3 +in both groups on the 1stday were also not statistically significant (P>0.05);The levels of CD4 +、CD4 +/CD8 +ratio in the laparotomy group were lower than the EST group on the 1st day postoperatively (P<0.05).The postoperative levels of CD3 +、CD4 +、CD4 +/CD8 +ratio in the laparotomy group were lower than the EST group on the 3rd and 5th day (P<0.05).Conclusion Compared with bile duct exploration with open surgery, the EST has minor tissue injury and slightly immune function inhabitant.Although the en-hanced inflammatory response occurs in a short time, after symptomatic treatment, EST is more beneficial for physiological and immune function in patients.In addition, it is envisioned that EST can be clinically widely used because it is simply operated, requires shorter operation time, causes less trauma and pain and minor complications.