腹腔镜手术对老年人体液免疫功能的影响

The Humoral Immune Response after Laparoscopic Cholecystectemy in the Elderly

目的：通过与同类型的剖腹手术比较，研究腹腔镜手术对老年患者体液免疫功能的影响。方法：分别测定８６例腹腔镜胆囊切除术（ＬＣ）的老年患者术前、术后 ２４、７２ ｈ和 ７ ｄ的白细胞总数、中性粒细胞数、淋巴细胞数、血清 ＩｇＧ、Ｍ、Ａ、补体 Ｃ３、Ｃ４，肿瘤坏死因子（ＴＮＦ）、白细胞介素 Ⅱ（ＩＬ—２）和 Ｃ反应蛋白（ＣＲＰ）并与剖腹胆囊切除术（ＯＣ，Ｎ＝７２）老年患者的测定值作比较。结果：ＬＣ患者术后 ２４ ｈ白细胞总数、中性粒细胞数轻度升高，至 ７２ ｈ均恢复正常。 ＬＣ术后 ７２ｈ内 ＩｇＧ、Ｃ３、ＴＮＦ和 ＩＬ－Ⅰ轻度降低，７ ｄ恢复正常。而 ＯＣ组不仅术后 ２４ ｈ白细胞总数、中性粒细胞数、血清 ＩｇＧ、ＩｇＭ、补体 Ｃ３、ＩＬ— ２、ＴＮＦ、和 ＣＲＰ均有不同程度升高，而且一直持续至术后 ７ ｄ，２组比较差异显著。结论：与 ＯＣ比较，ＬＣ的组织损伤小，因而术后神经内分泌改变和炎症反应较轻，恢复较快，对人体体液免疫功能的影响小。但ＬＣ术后短时间一些主要体液免疫指标降低的机制及其对患者恢复的影响尚待进一步研究。

Objective: To compare the changes in the humoral immune responses of aged patients undergoing laparoscopic or laparotomic cholecystectomy. Methods: In this study, humoral immunity parameters were compared prior to and 24h, 72 h and 7days after laparoscopic (LC) and laparotomic cholecystectomies (86 patients and 72 patients respectively). The following parameters were determined: Leucocyte, different counts of granulocytes and lymphocytes; serum IgG, IgA, IgM, C3, C4, tumor necrosis factor (TNF) , interleukin Ⅱ (IL - 2) and C - reactive protein (CRP ). Results: Granulocytes and the W .B.C counts increased mildly in LC group 24 h after surgery. They returned to normal after a recovery period of 72 hours. Also in LC group, small falls in the level of IgG.C 3.TNF and IL - Ⅱ occurred on postoperative 3 rd day with a return to the preoperative value on the 7 th day. The leucocytes, counts of granulocytes, serum levels of IgG, M, C3, IL - 2, TNF and CRP were increased significantly in the laparotomy group 24 h after surgery and persisted to the 7 th day. Conclusion: LC appears to be associated with less tissue destruction, lower inflammatory stimuli and neuroendocrine responses than laparotomy. These results suggest that laparoscopy show less effects on humoral immune response than laparotomy, but with transient humoral - immunesuppression. The mechanism for the reduction in humoral immune response is still unknown.