腹腔镜与开腹行急性胆囊切除术对体液免疫功能与机体能量代谢的影响比较

目的：比较腹腔镜与开腹行急性胆囊切除术对体液免疫功能与机体能量代谢的影响。 方法：将60例急性结石性胆囊炎患者随机地均分为观察组与对照组，每组各30例，观察组行腹腔镜胆囊切除术，对照组行开腹胆囊切除术。比较两组手术相关指标、手术前后免疫功能变化及能量代谢与营养指标的变化。 结果：与对照组比较，观察组手术时间、术中出血量明显减少，术后排气时间及下床活动时间明显缩短（均P<0.05）；两组术后IgG、IgM、IgA、C3、C4和IL-4水平以及静态能量消耗（REE）与呼吸商（RQ）值均较术前明显降低，但观察以上指标的降低程度小于对照组以及降低的持续时间短于对照组（均P<0.05）；两组术后7 d白蛋白（ALB）、转铁蛋白（TRF）、三头肌皮褶厚度（TSF）、上臂肌围（AMC）均较术前明显降低，但观察组的降低程度均低于对照组（均P<0.05）。 结论：腹腔镜急性胆囊切除术疗效优于开腹手术，且具有对体液免疫功能及影响小及能量代谢消耗少等优点。

Comparison of impacts between laparoscopic and open surgery on metabolism and humoral immune function in acute cholecystectomy

Objective: To compare influences between laparoscopic and open surgery on humoral immune function and energy metabolism in acute cholecystectomy. Methods: Sixty patients with acute calculous cholecystitis were randomly designated to observational group and control group with 30 cases in each group. Patients in observational group underwent laparoscopic cholecystectomy and those in control group were subjected to open cholecystectomy. The surgery-related parameters, and indexes associated with the changes in immune function, energy metabolism and nutrient loss in the two groups were compared. Results: The operative time, intraoperative blood loss, and time to first postoperative flatus and ambulation in observational group were significantly reduced compared with control group (all P<0.05). The levels of IgG, IgM, IgA, C3, C4 and IL-4, and values of resting energy expenditure (REE) and respiratory quotient (RQ) in both group were all decreased significantly compared with the preoperative ones, but the decreasing degrees in all the above parameters were less and the duration of their decreases were shorter in observational group than those in control group (all P<0.05). The levels of albumin (ALB) and transferrin (TRF) and the values of triceps skinfold thickness (TSF) and arm muscle circumference (AMC) in both groups at postoperative day 7 were all decreased significantly compared with the preoperative ones, but their decreasing amplitudes were all significantly less in observational group than those in control group (all P<0.05). Conclusion: Laparoscopic procedure for acute cholecystectomy has superior efficacy than open surgery, and it also has the advantages of lessened immune function alterations and reduced energy loss.