腹腔镜与开腹子宫切除术对机体免疫功能影响的比较研究

目的 :研究腹腔镜子宫切除术 (L H)和开腹子宫切除术 (AH)对机体免疫功能的影响。方法 :选择 70例有子宫切除指征的患者分为两组 ,分别行 L H和 AH各 35例 ,测定术前、术后 2 4小时指血白细胞 (WBC)计数、中性粒细胞比率(NGR) ,术前、术后 2 4小时和 48小时静脉血清白细胞介素 - 6 (IL- 6 )、白细胞介素 - 8(IL- 8)、免疫球蛋白 Ig G、Ig A、Ig M、C3、C反应蛋白 (CRP)水平。并比较两组的手术时间、术中出血量、术后镇痛用药、术后静脉输液日、住院日、和术后病率情况。结果 :AH组术后 2 4小时 WBC计数比术前明显增高 (P<0 .0 1) ,而 L H组增高不明显 (P>0 .0 5 ) ;两组术后 2 4小时的 NGR、术后 2 4和 48小时血清 IL- 6、IL- 8、CRP明显高于术前 (P<0 .0 1) ,但 AH组的上述指标均显著高于 L H组 (P<0 .0 1) ;两组术后 2 4和 48小时血清 Ig G均有下降 (P<0 .0 1) ,但 AH组较 L H组下降更明显 (P<0 .0 1) ;与 AH组相比 ,L H组术中出血少 ,术后镇痛用药少 ,输液少 ,术后病率低 ,住院日短。结论 :L H创伤较轻 ,引起机体免疫功能变化小 ,这为术后较快恢复提供了病理生理基础

Effects of Laparoscopic Hysterectomy and Laparohysterectomy on Immune Function in Patients

Objectives:To study the effects of gynecologic laparoscopy and laparohysterectomy on immune function in patients.Methods:Seventy hysterectomy patients were divided into the laparoscopic hysterectomy(LH)and abdominal hysterectomy(AH)groups with 35 in each group.The white blood cell(WBC),neutrophil granulocyte rate(NGR),in finger blood at 24 h before and 24 h after operation,interleukin-6(IL-6),interleukin-8(IL-8),IgG,IgA,IgM,complement 3(C3)and C-reactive protein(CRP)in serum from venous blood at 24 h before and 24 and 48 h after operation were measured.Operation time,bleed amount in operation,drug consumption,postoperative hospital stay and postoperative morbidity were compared between the tow groups.Results:It was demonstrated that WBC count increased significantly in AH group(P<0.01)but not in LH group(P>0.05)after operation.The NGR 24 h after operation,the contents of IL-6,IL-8,and CRP increased markedly at 24h and 48h postoperatively in both AH and LH groups(P<0.01),but significantly higher in the former(P<0.01).The IgG levels decreased markedly at 24 and 48 h postoperatively in both groups(P<0.01),but much lower in AH patients(P<0.01).Compared with AH group,LH group had less operation bleeding,drug consumption and postoperative infusion day,lower febrile morbidity,and shorter hospital stay.Conclusion:LH caused less effects on immune function and cytokines than AH in patients postoperatively because of less tissue injury,which would be advantageous for a rapid recovery.