腹腔镜与开腹胆囊切除术对腹腔免疫功能影响的比较

Compare the Influence of Laparoscopic and Open Cholecystectomy on the Immune Function of the Local Peritoneal Cavity

目的:比较腹腔镜与开腹胆囊手术对腹腔局部免疫功能的影响。方法:检测一组31例腹腔镜胆囊切除术患者(A组)和一组33例开腹胆囊切除术患者(B组)腹腔内渗液pH值、腹腔中性粒细胞吞噬功能、巨噬细胞产生TNFα生物学活性、腹腔T细胞亚群CD4+/CD8+的比值,并采用T检验比较两组各项指标的差异。结果:A组和B组腹腔pH值分别为7.13和7.39;中性粒细胞化学发光峰值为分别为98和102;L929细胞OD570值分别为0.183和0.152;CD4+/CD8+比值分别为0.53和0.57。除CD4+/CD8+比值外,其余三项指标的差异均有显著性。结论:与开腹胆囊切除术比较,腹腔镜胆囊切除术对腹腔局部免疫特别是细胞免疫有明显的抑制效应。此种免疫抑制效应源于CO2气腹所引起的局部内环境的酸性化,对巨噬细胞功能的影响犹为显著。胆囊有急性炎症者应慎行腹腔镜胆囊切除术。

Objective： To compare the influence of laparoscopic and open cholecystectoniy on the immune function of the local peritoneal cavity. Method： Determination of the pH value , phagocytic function of neutrophils ,the biological viability of TNF α produced by macrophages and the T lymphocytes subsets CD4 ＋/CD8 ＋ ratio of the peritoneal cavity in a group of 31 cases who underwent laparoscopie eholeeystectomy and in another group of 33 cases who underwent open eholecysteetomy. We used T test to compare the differ- ence of these 4 indexes between both groups. Result： Of these two groups, the average pH value were 7.13 and 7.39 respectively; The~ mean peak value of chemiluminescence was 98 and 102 respectively ; the mean OD570 of L929 Cells was 0.183 and 0.152 respectively; and the CD4 ＋/CD8 ＋ ratio was 0.53 and 0.57 respeetively. Except for the CD4 ＋/CD8 ＋ ratio, the difference of the other 3 indexes between both groups were of significance. Conclusion： Compared to open surgery, laparoseopie eholeeystectomy has obvious de- pressive effects on the immune functions particularly cell - mediated immune function of the local peritoneal cavity. Such immune depressive effects originate from the acidification of the intra peritoneal environment caused by CO2 pneumoperitoneum, and are more evident on macrophages. Therefore, laparoscopie eholecys- teetomy on patients with acute inflammation of the gallhladder should be very cautious.