腹腔镜与开腹胆囊切除术治疗胆囊结石对患者免疫功能及血清炎症因子的影响

目的:探讨腹腔镜与开腹胆囊切除术对患者免疫功能及血清炎性因子水平的影响.方法:收集符合标准的患者80例,采用简单随机分为观察组和对照组各40例,观察组应用腹腔镜胆囊切除术,对照组采用开腹胆囊切除术,分别于手术前、术后1d和术后5d检测静脉血免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG),T淋巴细胞亚群CD3+、CD4+、CD8+,以及超敏C-反应蛋白(hs-CRP)、白介素-6(IL-6)和人肿瘤坏死因子(TNF-α)等水平.结果:术后1d,两组患者血清IgA、IgM、IgG,外周血CD3+、CD4+,以及血清hs-CRP、IL-6和TNF-α水平较手术前均降低,外周血CD8+水平升高,差异有统计学意义(P<0.05).术后5d,观察组IgA、IgM、IgG、CD3+、CD4+、CD8+、hs-CRP、IL-6和TNF-α水平与手术前相似,差异无统计学意义(P>0.05);而对照组上述指标水平与手术前比较,差异有统计学意义(P<0.05).手术前,两组IgA、IgM、IgG、CD3+、CD4+、CD8+、hs-CRP、IL-6和TNF-α水平相似,差异无统计学意义(P>0.05);而术后1d、5d观察组上述指标水平优于对照组,差异有统计学意义(P<0.05).结论:腹腔镜与开腹胆囊切除术均具有一定创伤,影响患者机体免疫功能,但是前者具有创伤小、术后恢复快等特点.

Effects of Laparoscopic and Open Cholecystectomy on the Immune Function and Sserum Inflammatory Factors in Patients with Cholecystolithiasis

Objective: To investigate the effects of laparoscopic and open cholecystectomy on the im-mune function and serum inflammatory factors in patients with cholecystolithiasis. Methods:Totally 80 eligible patients were selected and randomly divided into observation group and control group, with 40 patients in each group. The observation group used laparoscopic cholecystectomy, while the control group used open cholecys-tectomy, and the levels of immune globulin A ( IgA ) , immune globulin M ( IgM ) , immune globulin G ( IgG) , T lymphocyte subpopulations CD3+, CD4+, and CD8+, hypersensitive C reactive protein ( hs-CRP ) , interleukin-6 ( IL-6 ) , and human tumor necrosis factor ( TNF-α) and so on in the venous blood were tested before surgery, at 1 d and 5 d after surgery, respectively. Results:At 1 d after surgery, the pa-tients of both groups had significantly decreased serum levels of IgA, IgM, and IgG, CD3+ and CD4+ in pe-ripheral blood, and serum levels of hs-CRP , IL-6, and TNF-α, as well as significantly increased CD8+lev-el in peripheral blood compared with those before surgery (P<0.05). At 5 d after surgery, the observation group had insignificantly different levels of IgA, IgM, IgG, CD3+, CD4+, CD8+, hs-CRP , IL-6, and TNF-α compared with those before surgery ( P>0.05);while the control group had significantly different levels of the above-mentioned factors compared with those before surgery (P<0.05). Before surgery, the two groups had insignificantly different levels of IgA, IgM, IgG, CD3+, CD4+, CD8+, hs-CRP , IL-6, and TNF-α( P>0.05);while at 1 d and 5 d after surgery, the observation group had significantly better levels of the above-mentioned factors than the controlled group (P<0.05). Conclusion: Laparoscopic cholecystectomy and open cholecystectomy have certain trauma, and can affect the immune function. However, the former has the char-acteristics of less trauma and faster postoperative recovery.