腹腔镜肝切除术患者细胞免疫功能的变化

Effect of laparoscopic hepatectomy on cellular immunity

目的 探讨腹腔镜下肝切除术对机体细胞免疫功能的影响。方法 选择15例ASAⅡ-Ⅲ级择期行腹腔镜下肝切除术的患者(LH组),观察其术前、术后第1天、术后第3天的外周血淋巴细胞亚群及IL-6和TNF-α的变化,并与同期15例开腹肝切除术患者(OH组)进行对比。结果 两组患者术后第1天成熟T淋巴细胞(CD3+)、辅助T淋巴细胞(CD4+)、抑制性T淋巴细胞(CD8+)较术前均有不同程度的降低(P<0.05),而IL-6、TNF-α较术前升高(P<0.05),但组间比较差异无显著性(P>0.05)。术后第3天LH组患者的CD3+、CD4+、CD8+以及IL-6、TNF-α基本上恢复至术前水平,而OH组患者CO3+、CD4+、CD8+仍低于术前、IL-6、TNF-α高于术前,组间比较差异有显著性(P<0.01)。结论 与开腹肝切除术相比,腹腔镜下肝切除术对患者细胞免疫功能影响轻且恢复快。

Objective To compare the effects of laparoscopic hepatectomy (LH) versus conventional laparotomy hepatectomy (CLH) on cellular immunity. Methods Fifteen ASA Ⅱ-Ⅲ patients aged 34-61 yrs, weighing 48-75 kg undergoing laparoscopic hepatectomy (LH) were studied. Another 15 patients aged 33-64 yrs, weighing 46-73 kg undergoing conventional laparotomy hepatectomy (CLH) served as control. The preoperative liver function was rated as Child classification A in both groups. The patients were premedicated with phenobarbital 0.1 g and atropine 0.5 mg i.m. . Anesthesia was induced with fenlanyl 4 μg·kg-1, propofol 1.5 mg·kg-1 and succinylcholine 2 mg·kg-1. After tracheal intubation the patients were mechanically ventilated and PETCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with inhalation of isoflurane (MAC 1.0±0.31) and 60% N2O in O2 and intermittent i.v. boluses of vecuronium. The patients received after operation patient-controlled epidural analgesia (PCEA) with 0.125% ropivacaine and morphine 0.05 μg·kg-1·min-1. Radial artery and right internal jugular vein were cannulated for BP and CVP monitoring. Peripheral venous blood samples were taken before operation and on the 1 st and 3rd postoperative day for determination of CD3+ , CD4+ , CD8+ T cells (by flow cytometry) and IL-6, TNF-αconcentrations (ELBA) . Results CD3+ , CD4+ and CD8+ counts were significantly decreased while IL-6 and TNF-αlevels were significantly increased on the 1st postoperative day compared with the baseline values before operation in both groups but there was no significant difference between the two groups. On the 3rd postoperative day CD3+ , CD4+ and CD8+ counts and IL-6, TNF-αlevels returned to preoperative level in group LH while in group CLH CD3+ , CD4+ , CD8+ remained low and IL-6, TNF-αlevels remained high.Conclusion The results suggest that LH exerts less effects on immune function than conventional laparotomy technique.