老年患者电视腹腔镜胆囊切除术围手术期免疫功能的研究

目的:通过对老年患者进行的腹腔镜胆囊切除术和开腹胆囊切除术进行观察,探讨其对老年患者围手术期免疫功能的影响.方法:将80例老年患者随机分为腹腔镜胆囊切除术(LC)和开腹胆囊切除术(OC)两组,于手术前1天、手术后24小时、48小时、72小时分别抽取患者静脉血,于术后24小时抽取腹腔引流液检测T细胞亚群分类、C-反应蛋白(CRP)、白介素-1(IL-1)等指标,分别观察同组手术前后及同期两组结果的不同.结果:术前OC组和LC组比较,CRP、CD4 、CD8 、CD4 /CD8 、IL-1均无明显差异(P＜0.05).OC组术后CRP、IL-1明显升高(P＜0.05),LC组术后CRP也升高,但升高幅度比OC组小,持续时间短,两组比较有显著性差异(P＜0.05).OC组术后CD8 明显升高,CD4 、CD4 /CD8 则明显下降(P＜0.05),LC组术后CD8 也明显升高(P＜0.05),但OC组升高幅度比LC组大,两组间比较有显著差异(P＜0.05).LC组手术前后CD4 、CD4 /CD8 和IL-1则始终变化不明显.结论:LC和OC术后早期都抑制机体的免疫功能,但LC组的抑制程度较OC组轻,持续时间短;OC组对腹膜腔局部免疫功能的抑制也比LC组明显;腹腔镜手术对免疫机能下降的老年患者可能减少围手术期的感染并发症和肿瘤转移的机会.

The Research of Immune Function in Old Patients Undergoing Laparoscopic Cholecytectomy

Objective: To observe the old patients undergoing open cholecstectomy(OC) and laparoscopic cholecystectomy(LC), and discuss the influence of postoperative immune function of old patient.Methods: 80 cases were random divided into twogroups: OC group and LC group. Immune parameters including serum contents of IL--1, CRP, CD_4~+ and CD_8~+ were assessed at preoper-ative 24 hours and at postoperative 24, 48, 72 hours. The drainags of abdominal cavity at postoperative 24 hours were assessedtoo.Results:The levels of CRP, CD_4~+, CD_8~+, IL--1, CD_4~+/CD_8~+ were not different between OC group and LC group before opera-tion. The leves of CRP and IL--1 in OC group were significantly increased after operation (P < 0. 05). The level of CRP in LCgroup were significantly increased too, and they were lower and quicker than OC group. There was significant difference between twogroups. After operation, the levels of CD_8~+ in OC group were significantly increased, and CD_8~+, CD_4~+/CD_8~+ in OC group were signifi-cantly decreased, the levels of CD_8~+ in LC group were obviously increased too. But the change in the OC group was obviously higherthan that in LC group. And there was significant difference between two groups. The levels of CD_4~+,CD_8~+ and IL--1 were not differ-ent in LC group between before and after operation. Conclusion: Both OC and LC can cause depression of immune function in the earli-er postoperative period. But LC cause less depression of immune function than OC does and the recovery of the immunosuppression inLC group is more quickly than in OC group. The suppression of peritoneal immune function in OC group is obvious than in LC group.LC maybe helpful to decrease the chance of infection and tumor spreading in old patients who have the immunosuppression.