妇科腹腔镜手术对机体免疫功能的影响

Effect of gynecological laparoscopic surgery on immune function

目的:研究妇科腹腔镜手术对机体免疫功能的影响,为腹腔镜手术微创性提供更多的理论依据。方法:选择83例子宫肌瘤、卵巢良性畸胎瘤、卵巢上皮性肿瘤及卵巢子宫内膜异位囊肿患者,其中腹腔镜组(LS组)43例,开腹手术组(OS组)40例,比较两组围手术期一般状况、手术前后白细胞(WBC)数、中性粒细胞(NEU)数、白细胞介素2、4(IL-2,IL-4)及免疫球蛋白IgA、IgG、IgM的水平。结果:①两组术后第1天血WBC数和NEU数较术前均明显升高(P<0.05),且开腹组较腹腔镜组升高幅度大(P<0.05),术后第4天均恢复到术前水平(P<0.05)。②两组术后第1天IL-2均明显降低,开腹组下降幅度大(P<0.05),术后第4天腹腔镜手术组逐渐恢复,而开腹手术组仍明显低于术前,两组间差异有统计学意义(P<0.05)。两组术后第1天IL-4均明显升高(P<0.05),且开腹组较腹腔镜组升高幅度程度大(P<0.05),术后第4天腹腔镜已恢复到术前水平,开腹组仍明显高于术前,两组间差异有统计学意义(P<0.05)。③免疫球蛋白IgA、IgM在术前、术后两组均无明显变化(P>0.05),两组免疫球蛋白IgG术后均明显下降(P<0.05),且两组间差异有统计学意义(P<0.05)。④与开腹手术相比,腹腔镜手术时间短、术中出血量少、术后排气时间短、术后病率低。结论:对于妇科良性疾病,在掌握好手术适应证的前提下,腹腔镜手术与开腹手术相比,对机体免疫功能抑制作用小,有利于术后患者的恢复。

Objective： To research the effect of gynecological laparoscopic surgery on immune function, provide more theoretical basis for minimal invasion of laparoscopic surgery. Methods： A total of 83 patients with hysteromyoma, ovarian benign teratoma, epithelial ovarian tumor, and endometriosis were selected, including 43 patients in laparoscope group and 40 patients in laparotomy group; the general conditions, the counts of white blood cells before and after surgery, the counts of neutrophile granulocytes, and the levels of interleukin - 2, interleukin - 4, IgA, IgG, and IgM in the two groups were compared. Results ： The counts of white blood cells and neutrophile granulocytes on the first day after surgery in the two groups were statistically significantly higher than those before surgery （ P 〈 0. 05 ） , especially in lapa- rotomy group （ P 〈 0. 05 ） . The counts of white blood cells and neutrophile granulocytes on the fourth day after surgery returned to normal （ P 〈 0.05 ） . The levels of interlenkin - 2 on the first day after surgery in the two groups decreased significantly, especially in laparotomy group （ P 〈 0. 05 ） , the level of intedeukin - 2 in laparoscope group recovered gradually on the fourth day after surgery, but the level of inter- leukin- 2 in laparotomy group was still statistically significantly lower than that before surgery, there was statistically significant difference between the two groups （ P 〈 0. 05 ） . The levels of interleukin - 4 on the first day after surgery in the two groups increased significantly （ P 〈 0. 05 ） , especially in laparotomy group （ P 〈 0. 05 ） , the level of interleukin - 4 in laparoscope group returned to normal on the fourth day after surgery, but the level of interleukin - 4 in ]aparotomy group was still statistically significantly higher than that before surgery, there was statistically significant difference between the two groups （ P 〈 0. 05 ） . In the two groups, there was no statistically significant difference in the levels of IgA and IgM between before and after surgery （ P 〉 0. 05 ） . After surgery, the levels of IgG in the two groups decreased signifi- cantly （ P 〈 0. 05 ）, and there was statistically significant difference between the two groups （ P 〈 0. 05 ） . Compared with laparotomy, lapa- roscopic surgery had the advantages of shorter operation time, less amount of intraoperative blood loss, shorter postoperative exhausting time, and lower postoperative morbidity. Conclusion： For the women with benign gynecological diseases, under the precondition of grasping surgical indications, compared with laparotomy, laparoscopic surgery has less inhibiting effect on immune function, and it is beneficial to recovery of the patients after surgery.