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腹腔镜胆囊切除术对机体免疫功能的影响

来源:华世论文网
 

       作者:李学华 隋永领 胡三元 李洪光 刘志恒 刘桂杰

【摘要】    目的:比较腹腔镜与开腹胆囊切除术对机体免疫功能的影响。方法:随机将有胆囊切除手术指征的80例患者分为2组,腹腔镜胆囊切除组(laparoscopic cholecystectomy,LC组)和开腹胆囊切除组(open cholecystectomy,OC组)各40例,测定并比较手术前后IgG、IgM、IgA,补体C3、C4水平及CD3+(T细胞总数)、CD4+(T辅助/诱导细胞)和CD8+的数量。结果:两组IgM、IgA、C4手术前后均无明显变化,两组间差异无统计学意义。LC组术后1d IgG、C3较术前有所下降,术后3d恢复至术前水平;OC组术后1d IgG、C3明显低于术前水平,术后5d恢复至术前水平;组间比较,OC组术后IgG、C3下降明显。LC组T淋巴细胞亚群手术前后差异无统计学意义,OC组术后1d CD3+、CD4+、CD8+与术前比较明显降低,术后5d恢复至术前水平;组间比较,术后1d、3d OC组CD3+、CD4+、CD8+均明显低于LC组。结论:腹腔镜手术对机体的免疫功能影响小,术后恢复快。

【关键词】  胆囊切除术 腹腔镜 免疫测定 T淋巴细胞

  The influence of laparoscopic cholecystectomy on immune function   
  【Abstract】  Objective:To compare the influence of laparoscopic cholecystectomy(LC) and open cholecystectomy(OC) on immune function.Methods:Eighty patients with operation indication for cholecystectomy were divided randomly into laparoscopic cholecystectomy(LC,n=40)and open cholecystectomy(OC,n=40).Serum concentration of IgG,IgM,IgA,complement 3,4(C3,C4),as well as peripheral blood levels of CD3+,CD4+,CD8+ lymphocytes were measured and compared in both groups preoperatively and postoperatively.Results:There were no significant difference between preoperative and postoperative concentration of IgA,IgM and C4 in both groups.IgG and C3 decreased on postoperative 1st day in LC group,and returned to the preoperative level on postoperative 3rd day.IgG and C3 significantly decreased on postoperative 1st day in OC group,and returned to the preoperative level on postoperative 5th day.The postoperativc IgG and C3 were singificantly lower in OC group than those in LC group.In OC group,the levels of CD3+,CD4+,CD8+ lymphocytes decreased on postoperative 1st day,and returned to the preoperative level on postoperative 5th day.The levels of CD3+,CD4+,CD8+ lymphocytes on postoperative 1st,3rd day in LC group were lower than those in OC group.Conclusions:LC has less influence on immune function than OC.The immune function of patients with LC can recover more rapidly after operation.
   
  【Key words】  Cholecystectomy,laparoscopic;Immune function;T?lymphocytes

    2005年1月至2007年1月我们将80例患者分组施行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与开腹胆囊切除术(open cholecystectomy,OC),并于手术前后检测了患者的免疫球蛋白、补体及T淋巴细胞亚群,分析了两种术式对机体免疫功能的影响。

  1  资料与方法

  1.1  临床资料 

  80例中男28例,女52例;16~76岁,平均51岁。随机将患者分为2组,腹腔镜组(LC组)和开腹组(OC组)各40例,两组患者在性别、年龄、体重、身高等方面无统计学差异。

  1.2  研究方法 

  两组患者均于术前及术后1、3、5d清晨空腹抽取静脉血2ml,检测免疫球蛋白、补体和T淋巴细胞亚群,测定数据用SPSS11.0软件处理,用χ2检验和t检验比较两组差异的显著性。

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