经腹腔镜、开腹胆囊切除术对老年患者血清C反应蛋白、IL－6、TNF－α的影响

目的探讨经腹腔镜、开腹胆囊切除术对老年患者围手术期血清C反应蛋白、IL－6、TNF－α的影响。方法选取100例结石性胆囊炎老年患者（年龄〉60岁），根据手术方式分为经腹腔镜胆囊切除术组（LC组，50例）及开腹切除术组（OC组，50例），均于术前1d及术后24h、48h、72h抽取肘静脉血2ml，分离血清检测C反应蛋白、IL－6、TNF－α含量。结果术后24h、48h、72h两组血清C反应蛋白、IL－6、TNF－α含量均显著升高（P〈0．01）。术后24h、48h、72hLC组的血清C反应蛋白、IL－6、TNF－α含量均显著低于OC组（P〈0．01）；术后72hLC组的血清C反应蛋白含量恢复到术前Id水平（P〉0．05），且下降的幅度较快（P〈0．01）。结论经腹腔镜、开腹胆囊切除术均可引起血清C反应蛋白、IL－6、TNF－α含量升高。LC与OC相比较，LC对于术后老年患者机体免疫功能影响较小。

The influence of laparoscopic cholecystectomy and open cholecystectomy on serum C reactive protein,IL-6,TNF-α in elderly patients

Objective To investigate the influence of laparoscopic cholecystectomy （LC） and open cholecystectomy （OC） on serum C reactive protein, IL-6, TNF- α in elderly patients. Methods 100 elderly patients with calculous cholecystitis were randomly divided into LC group and OC group, with 50 cases in each group. All of the patients were phlebotomized 2 ml fasting elbow venous blood 1 day before surgery, 24, 48, 72 hours after surgery. The levels of serum C reactive protein, IL-6, TNF- α were detected by enzyme linked immunosorbent assay （ELISA）. Results The levels of C reactive protein, IL-6, TNF- α significantly increased 24, 48, 72 h after surgery in both two groups （P 〈 0.01）. The levels of C reactive protein, IL-6, TNF-α in LC group 24, 48, 72 h after surgery were significantly lower than those in OC group （P 〈 0.01）. The level of C reactive protein in LC group 72 h after surgery returned back to the level on the first day before surgery （P 〉 0.05）, with a faster decline speed （P 〈 0.01）. Conclusion Laparoscopic cholecystectomy and open cholecystectomy would both lead to the raise of serum C reactive protein, IL-6, TNF- α. Compared with open cholecystectomy, laparoscopic cholecystectomy has little influence on immune function in elderly patients after surgery.