腹腔镜手术治疗消化性溃疡穿孔对机体炎症反应及免疫功能的影响

目的 探讨腹腔镜手术治疗消化性溃疡穿孔对机体炎症反应及免疫功能的影响,进一步评价腹腔镜穿孔修补术的微创效果.方法 将81例消化性溃疡穿孔患者随机分为腹腔镜手术组（腹腔镜组,37例）和开腹手术组（开腹组,44例）,比较两组患者围手术期外周血降钙素原（PCT）、C反应蛋白（CRP）及T淋巴细胞亚群（CD4、CD8、CD4/CD8比值）变化.结果 术后第1天、第3天两组的PCT、CRP均较术前显著升高（P＜0.05）.术后第5天腹腔镜组的PCT、CRP水平与术前比较,差异无统计学意义（P＞0.05）.术后开腹组的PCT、CRP水平均显著高于腹腔镜组（P＜0.05）.两组术后第1天CD4、CD8水平及CD4/CD8比值均较术前显著下降（P＜0.05）,但术后腹腔镜组CD4、CD8水平及CD4/CD8比例明显高于开腹组（P＜0.05）,且腹腔镜组CD4、CD8水平及CD4/CD8比值均于术后第5天恢复至术前水平（P＞0.05）.结论 与开腹穿孔修补术相比较,腹腔镜穿孔修补术能够有效降低术后炎症反应的程度,且对机体的免疫功能影响更小,具有功能学微创优势.

Impact of laparoscopic surgery on inflammatory response and immune function in patients with peptic ulcer perforation

Objective To investigate the impact of laparoscopic surgery on inflammatory response and immune function in patients with peptic ulcer perforation and further evaluate the minimally invasive effect of laparoscopic surgery.Methods Eighty-one patients with peptic ulcer perforation were randomly divided into laparoscopic surgery group （LS group,n =37）and open surgery group （OS group,n =44） from August 2010 to February 2013.Procalcitonin （PCT）,C-reactive protein （CRP）,and T lymphocyte （CD4,CD8 and CD4/CD8 ratio）of peripheral blood were assayed perioperatively.Results The levels of PCT and CRP in both groups were significantly increased on the 1st and 3rd day postoperatively（P ＜ 0.05）.PCT and CRP levels in the LS group returned to the preoperative levels on the 5th day postoperatively（P ＞ 0.05）.Postoperative levels of PCT and CRP in the OS group were significantly higher than those in the LS group（P ＜ 0.05）.Levels of CD4,CD8 and CD4/CD8 ratio in both groups were significantly decreased on the 1st day postoperatively（P ＜ 0.05）,but the postoperative levels of CD4,CD8 and CD4/ CD8 ratio in LS group were significantly higher than those in the OS group（P ＜ 0.05）.Levels of CD4,CD8 and CD4/CD8 ratio of LS group returned to the preoperative level on the 3rd day postoperatively （P ＞ 0.05）.Conclusion Compared with open peptic ulcer perforation repair surgery,laparoscopic peptic ulcer perforation repair can effectively reduce the degree of irdlammation and have smaller effects on immune function and functional advantages of minimal invasion.