腹腔镜、传统术式与小切口胆囊切除术对患者血清IL-2、IL-6、TNFα-的影响

The influence of Laparoscopic cholecystectomy,Opencholecystectomy and Miniincision open cholecystectomy on the serum IL-2,IL-6,TNF-α

目的探讨腹腔镜、传统术式与小切口胆囊切除术对患者血清IL-2、IL-6、TNF-α的影响。方法将180例胆囊炎、胆石症患者根据手术方式分为腹腔镜胆囊切除术组(LC组,60例)、开腹切除术组(OC组,60例)及小切口胆囊切除术组(MC组,60例),均于术前1 d及术后第1、3、5 d清晨抽取空腹静脉血2 ml,分离血清检测IL-2、IL-6、TNFα-含量,并比较三组平均手术时间。结果术后1、3 d三组血清IL-2含量显著降低(P<0.01),术后5 d LC组血清IL-2含量恢复到术前1 d水平(P>0.05);术后1、3、5 d LC组的血清IL-2含量均显著高于OC、MC组(P<0.01)。术后1、3 d三组血清IL-6、TNF-α含量显著升高(P<0.01),术后5 d LC组血清IL-6、TNF-α含量恢复到术前1 d水平(P>0.05);术后1、3、5 d LC组的血清IL-6、TNF-α量均显著低于OC、MC组(P<0.01)。LC组平均手术时间与OC组、MC组比较均有统计学意义(P均<0.01),OC组与MC组比较也有统计学意义(P<0.05),LC组手术时间最短。结论腹腔镜、传统术式与小切口胆囊切除术均可引起血清IL-6、TNF-α含量升高,血清IL-2降低。LC与OC及MC相比较,创伤微小,手术时间较短,术后疼痛轻微,对机体免疫功能影响较小,LC比OC及MC更适合于患者。

Objective To investigate the influence of Laparoscopic cholecystectomy（LC）,Opencholecystectomy（OC） and Miniincision open cholecystectomy（MC） on the serum IL-2,IL-6,TNF-α.Methods 180 patients with gallstone were randomly divided into LC group,OC group and MC group.All of the patients were phlebotomized 2 ml fasting venous blood one day before surgery the 1st,3rd and the 5th day after surgery.The levels of serum IL-2,IL-6 and TNF-α in were detected by enzyme linked immumosorbent assay（ELISA）.The surgery time of three groups were compared.Results The level of IL 2 decreased in the 1st,3rd day after surgery（P0.01）,and returned back to the level as the one day before surgery in the 5th day after surgery in the group LC.The level of IL 2 of group LC was higher than those of the other two groups in the 1st,3rd day and the 5th day after surgery（P0.01）.The level of IL-6 and TNF-α in three groups signifcantly increased in the 1st,3rd day after surgery,and returned back to the level as the one day before surgery in the 5th day after surgery in the group LC.The level of IL-6 and TNF-α of group LC was lower than those of the other two groups in the 1st,3rd day and the 5th day after surgery（P0.01）.There was significant difference of the average surgery time between group LC and group OC and MC（P0.01）.Conclusion Laparoscopic cholecystectomy and open cholecystectomy and Miniincision open cholecystectomy would make the serum IL-6 and TNF-α raised and IL-2 decreased.Laparoscopic cholecystectomy has little trauma and a short surgery time and little influence on the immune function.It is more suitable for the patients.