腹腔镜手术治疗子宫内膜异位症对机体免疫功能的影响

Effect of laparoscopic surgery on the immune function of patients with endometriosis

目的探讨腹腔镜手术治疗子宫内膜异位症(EMS)对机体免疫功能的影响。方法选择60例有手术指征的EMS患者分为两组,各30例分别实施腹腔镜手术及开腹手术,并于手术前、术后1d和术后3d时取静脉血,流式细胞仪测定外周血T细胞亚群CD3、CD4、CD8,散射比浊法测定免疫球蛋白IgM、IgG、IgA、补体C3、C4以及血清C反应蛋白(CRP),ELISA双抗体夹心法测定血清IL-6和肿瘤坏死因子(TNF-α)。结果两组患者手术前后T细胞亚群及IgM、IgA、C4无显著性差异(P>0.05);IgG、C3术后1d时较术前下降(P<0.05),术后3d时恢复至接近术前水平;但开腹手术组较腹腔镜手术组下降更明显(P<0.01);血清IL-6、TNF-α和CRP水平在术后1d时较术前上升(P<0.01),术后3d时明显回落,但开腹手术组的上述指标均显著高于腹腔镜手术组(P<0.01)。结论腹腔镜手术治疗EMS患者损伤小,对炎症相关因子有一定影响,对机体的细胞免疫和体液免疫功能均影响轻微,且恢复迅速,是EMS患者腹腔镜术后迅速康复的免疫学依据。

Objective To investigate the effect of laparoscopic surgery on the immune function of patients with endometriosis. Methods Blood samples were obtained from 36 patients undergoing laparoscopy for endometriosis before and 1 day and 3 days after the operation. Peripheral blood T-cell subsets CD3, CD4, and CD8 were determined with flow cytometry, the levels of IgM, IgG, IgA, Complement （C）3, C4, C-reactive protein and （CRP） were detected with turbidimetry, and the levels of interleukin-6 （IL-6） and tumor necrosis factor-alpha （TNF-α） were measured with enzyme linked immunosorbent assay （ELISA）. Results No significant variation were found in the T-cell subsets, IgM, IgA, C4 after the operation （P〉0.05）. The levels of IgG and C3 1 day after the operation were significantly lower than the preoperative levels （P〈0.05） and nearly recovered the preoperative level 3 days after operation. Serum concentration of IL-6, TNF-α, and CRP 1 day after the operation were significantly higher than the preoperative levels （P〈0.01） and decreased 3 days after the operation. Conclusion The immune function of patients with endometriosis is mildly affected by laparoscopic surgery and recover rapidly, which may be one of the reasons for quick recovery of patients after laparoscopy for endometriosis.