腹腔镜胃大部切除术对机体免疫功能的影响

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。

Effects of laparoscopic subtotal gastrectomy on immune functions

Objective:To compare the effect of laparoscopic subtotal gastrectomy with that of laparotomy on immune functions.Methods:Forty cases indicated to subtotal gastrectomy underwent either laparoscopic subtotal gastrectomy(LG group,20 cases) or open subtotal gastrectomy(OG group,20 cases).Serum levers of IgG,IgM,IgA,C3 and C4 measured by the nephelometry,and T lymphocyte subpopulations,including CD3+(total T cells),CD4+(T helper/T inducer)and CD8+(T suppressor/T cytotoxic)measured by the flow cytometry,were compared between the two groups.Results:Serum levels of IgM,IgA and C4 showed no apparent changes before and after operation in both groups.The IgG and C3 levels decreased on the day 1 and restored to normal on the day 3 postoperatively in both groups,but much lower in the OG group on the day 1 after operation(P<0.01).The levels of CD3+,CD4+ and CD8+ in the OG group decreased significantly on the postoperatively day 1 and 3 (P<0.01) and recovered to preoperative level on the postoperative day 5,while those in the LG group changed without statistical significance before and after operation.The levels of CD3+,CD4+and CD8+ were significantly lower in the OG group than those in LH group on the postoperative day 1 and 3.Conclusions:Compared with abdominal subtotal gastrectomy,laparoscopic subtotal gastrectomy has less side effect on immune functions and patients in LG recover rapidly after operation.