腹腔镜与开腹子宫切除术对免疫功能影响的比较

Effects of laparoscopic versus abdominal hysterectomy on immune functions

目的比较腹腔镜与开腹子宫切除术对机体免疫功能的影响。方法选择44例有子宫切除指征的患者,分为2组:腹腔镜治疗25例(腹腔镜组),接受开放手术19例(开腹组)。比较两组的手术时间、术中出血量、术后镇痛用药、术后住院时间情况;并采用散射比浊法测定免疫球蛋白IgG、IgM、IgA,补体C3、C4水平,采用流式细胞仪测定CD3+(T细胞总数)、CD4+(T辅助/诱导细胞)、CD8+(T抑制/杀伤细胞)的数量,进行组间比较。结果两组手术时间(100.5±15.9 m invs 97.0±17.9 m in)无显著性差异(t=0.685,P=0.497),腹腔镜组术中出血量(65.0±48.9 m l vs 150.0±100.4 m l)、术后镇痛率(3/25 vs 16/19)及术后住院时间(5.4±1.3 d vs 7.4±1.5 d)明显小于开腹组(t=-3.703,2χ=22.943,t=-4.730;P=0.000)。两组IgM、IgA、C4手术前后均无明显变化,两组间亦无显著差异。腹腔镜组术后1 d IgG较术前有所下降,术后3 d恢复至术前水平,C3无明显变化;开腹组IgG、C3术后1 d明显低于术前水平,术后3 d恢复到术前水平。两组比较,开腹组术后1 d IgG、C3下降明显。腹腔镜组T淋巴细胞亚群手术前后均无显著性差异。开腹组术后1、3 d CD3+、CD4+、CD8+与术前比较均明显降低,术后5 d恢复至术前水平;两组比较,术后1、3 d开腹组CD3+、CD4+、CD8+均明显低于腹腔镜组。结论腹腔镜对机体免疫功能的影响小,为术后恢复较快提供了病理生理学依据。

Objective To compare laparoscopic with abdominal hysterectomy in their effects on immune functions. Methods Forty-four patients scheduled for hysterectomy were given either laparoscopic hysterectomy （LH Group. 25 cases） or abdominal hysterectomy （AH Group, 19 cases）. The operation time, intraoperative blood loss, analgesic consumption, postoperative hospital stay, and postoperative pyrexia rate were compared between the two groups. Serum levels of IgG, IgM, IgA, Complement 3 （C3 ）, and Complement 4 （C4 ）, measured by using the nephelometry, and T lymphocyte subpopulations, including CD3 ^± （ total T cells）, CD4^± （T helper/T inducer）, and CD8 ^± （T suppressor/T cytotoxic）, measured by using the flow cytometry, were compared between the two groups, respectively. Results There was no significance in operation time between the two groups （ 100.5 ± 15.9 min vs 97.0 ± 17.9 min; t =0. 685, P = 0. 497 ）. Compared with the AH Group, the LH Group had significantly less intraoperative blood loss （65.0 ± 48.9 ml vs 150.0 ± 100.4 ml; t = - 3. 703, P = 0. 000） , lower analgesic consumption （3/25 vs 16/19; χ^2 =22.943, P=0.000）, and shorter postoperative hospital stay （5.4±1.3 d vs7.4±1.5 d; t= -4.730, P=0.000）. Serum levels of IgM, IgA, and C4 showed no apparent changes before and after operation in both groups. The IgG levels decreased on the 1 day and restored to normal on the 3 day postoperatively in both groups, but much lower in the AH Group on the 1 dav after operation （P 〈 0.01 ）. The C3 levels kept unchanged in the LH Group but significantly decreased in the AH Group after operation. The levels of CD3^＋ , CD4^＋ , and CD8 ^＋ in the AH Group decreased significantly on the 1 and 3 postoperative day （P 〈 0.01 ） and recovered to preoperative levels on the 5 postoperative day, while those in the LH Group changed without statistical significance before and after operation. The levels of CD3 ^＋, CD4 ^＋ , and CD8^＋ were significantly lower in the AH Group than in the LH Group on the 1 and 3 postoperative day. Conclusions As compared with abdominal hysterectomy, laparoscopic hysterectomy caused less influence on immune functions, which is pathophysiologically advantageous for a rapid recovery.