腹腔镜胆道探查取石术与传统开放手术对机体创伤和免疫影响的研究

Research on operative wound and immune function change between laparoscopic choledochotomy and conventional choledochotomy

目的:比较腹腔镜胆道探查取石术与传统开放手术对机体创伤及免疫的影响。方法:将胆道结石患者40例分成两组,腹腔镜组20例,传统手术组20例,两组男女各10例,47～72岁。由同一手术组施术。分别于术前1d和术后3d及7d抽取外周静脉血监测相应的实验指标,同时监测两组临床观察指标。结果:创伤指标(WBC,NE%,L%,血糖,CRP,TNF-α,IL-6),免疫学检测指标(IgG,IgA,IgM,C3,C4,CD3+,CD4+,CD8+,NK),临床指标(手术时间、术中出血量、术后疼痛评分、SIRS发生和持续时间、术后通气时间、术后并发症、住院时间)腹腔镜组均优于传统手术组。结论:腹腔镜胆道探查取石术与传统开放手术相比,手术切口小、术中出血少、术后肠道功能恢复快、疼痛轻、住院时间短、应激指标升高与免疫指标减少较低,且术后恢复较快,对机体免疫功能和应激反应影响小,能更好的减少机体创伤,保护机体免疫功能,患者术后康复快,体现了腹腔镜胆道手术的微创性。

Objective：To evaluate and compare the operative wound and immune function change between laparoscopic choledochotomy and conventional choledochotomy.Methods：From May 2008 to Oct.2008,the clinical data of 20 cases receiving laparoscopic choledochotomy were compared with 20 cases receiving conventional choledochotomy.40 patients were divided into two groups,the laparoscopic group（LG） and conventional group（CG）.Each group had been operated by the same operation group.The differences in laboratory result and clinical data of these two groups were examined and compared.Results：The levels of plasma proinflammatory factors,such as TNF-α,IL-6,WBC,NE%,L%,BG,CRP,IgG,IgA,IgM,C3,C4,CD3^＋,CD4^＋,CD8^＋,CD3^＋CD4^＋/CD3^＋CD8^＋and clinic data,such as the operating time,post-operation hospitalization,the average bleeding volume,complication,the wound incision length showed that LG were better than CG.Conclusions：The differences between the two groups are significant,and LG has its fabulous advantages.The bleeding volume,incision length,average hospital stay and postoperative recovery in laparoscopic choledochotomy were superior to those in the open operation.Furthermore,the laboratory examination of stress and immune indicators shows that laparoscopic choledochotomy can reduce stress and protect body immune system better than traditional operation.Although the technical difficulty in laparoscopic choledochotomy approach was greater,the operating efficiency was better than that via the open approach.The laparoscopic choledochotomy possesses less injury and hospital stay,rapid recovery better,safety and effectiveness,and have bright foreground of clinical application.