腹腔镜下幽门环肌切开术对患儿细胞免疫的影响

目的探讨腹腔镜下幽门环肌切开术围手术期CO2气腹对患儿细胞免疫的影响及临床意义。方法选择40例先天性肥厚性幽门狭窄患儿，随机分为腹腔镜组和开腹组，分别于术前及术后1d、3d监测围手术期CD3、CD4、CD4／CD8的变化。结果开腹组CD4术后1d轻微下降，术后3d明显升高，术后1d与3d比较，差异有显著统计学意义（P=0．007）；开腹组CD4／CD8术后1d下降，与术前比较，差异有统计学意义（P=0．044）；术后3d升高，与术后1d比较，差异有显著统计学意义（P=0．003）。腹腔镜组CD4术后1d下降，与术前比较，差异有显著统计学意义（P=0．023），术后3d明显升高，与术前比较，差异无统计学意义（P=0．596）；两组比较CD4／CD8腹腔镜组较高，差异有显著性（F=3．961，P〈0．05）结论新生儿及婴儿腹腔镜手术可引起机体免疫功能的改变，腹腔镜组对机体免疫功能的影响较小。

Effect of cardon dioxide pneumoperitomeum on children's cellular immunity during laparoscopic pyloromyotomy

Objective To investigate the effect of cardon dioxide pneumoperitomeum on children's cellular immunity during laparoscopic pyloromyotomy and clinical meaning. Methods 40 patients with congenital hypertrophic pyloric stenosis were divided into two groups: group A (which were underwent laparotomy) and group B (which were underwent laparoscopy) at random. The CD3,CD4,CD8,CD4 / CD8 were measured in each patient at perioperation. Results In group A,at the first day after operation,the CD4 were declined slightly. At the third day after operation,the CD4 were rised clearly and were different significantly with the first day after operation (P < 0.05). At the first day after operation,the CD4 / CD8 were declined and were different significantly with preoperation (P < 0.05). At the third day after operation,the CD4/CD8 were rised and were different significantly with 1 day after operation(P<0.05). In group B,at the first day after operation,the CD3 were declined and were different significantly with preoperation (P < 0.05). at the third day after operation,the CD3 were rised obviously and were different significantly with the first day after operation(P < 0.05). The CD4 / CD8 in group B were higher than group A and were different significantly (P < 0.05). Conclusions During laparoscopy in neonate and younger infants,surgical trauma can bring the changes of immunity function. The effect of cardon dioxide pneumoperitomeum on children's immunity is less.