腹腔镜与开腹胆囊切除术对老年人白细胞、抗体和补体数量的影响

The Impact of Laparoscopic and Open Cholecystectomy on the Quantities of the WBC,Antibody and Complement of Elderly People

目的:研究腹腔镜胆囊切除术(LC)和开腹胆囊切除术(OC)对老年人白细胞(WBC)、抗体(Ab)、补体(C)的影响。方法:选择60例有胆囊切除指征的老年患者(年龄≥60岁)分为两组,分别行LC和OC各30例,测定术前、术后24小时和72小时血白细胞计数(WBC)、中性粒细胞比率(NGR),术前、术后24小时和72小时静脉血清免疫球蛋白IgG、IgA、IgM、C3、C4水平。并比较两组的手术时间、术中出血量、术后镇痛用药率、术后静脉输液日、住院日和术后并发症情况。结果:OC组术后24小时WBC计数比术前明显增高(P<0.01),而LC组增高不明显(P>0.05);两组术后24小时的NGR明显高于术前(P<0.01),但OC组的上述指标均显著高于LC组(P<0.01);两组术后24和72小时血清IgG、C3、C4均有下降(P<0.05),但OC组较LC组下降更明显(P<0.01);与OC组相比,LC组手术时间短,术中出血少,术后镇痛用药少,输液少,术后病发症率低,住院日短。结论:LC创伤较轻,引起机体WBC、Ab、C变化小,更适用于老年患者。

Objective：To study the impact of laparoscopic and open cholecystectomy on the quantities of the WBC, Antibody Comlement of elderly people. Methods：60 patients who have the indication of cholecystectomy were divided into two groups. They are treated by laparoseopic and open cholecystectomy,30 cases each. White blood cell count（WBC） and neutrophilic granulyte rate（NGR） were measured before and 24 hours after operation. The lever of Intravenous immune serum globulin （ IgG, IgA, IgM, C3, CA ） were also measured before and 24hours, 72hours after operation. The operation time,blood loss during operation, Postoperative analgesic medication, the days of postoperative intravenousinfusion, admis- sion days and the rate of postoperative complications were compared. Results：White blood cell count （WBC） of open chole- cystectomy group was significantly elevated 24 hours after operation （ P 〈 0.01 ）, while the change The change of laparoscop- ic cholecystectomy was not obvious（P 〉0.05）. 24hours after operation,the NGR of two group increased compared with that before（P 〈 O. O l ）, but these indexes of open cholecystectomy group were significantly above laparoscopic cholecystectomy group（P 〈0. Ol ）. 24hours and 72hours after operation,the blood serum（IgG,C3 ,CA） of two group all have fallen（P 〈0. 05 ）, while open cholecystectomy group is more obvious than laparoscopic cholecystectomy group （ P 〈 O. 01 ）. Conclusion： with open cholecystectomy,laparoscopic cholecystectomy has such advantages： shorter operatic time, Less bleeding and Postop- erative analgesic medication,less infusion, decreased complication and Shorter hospital stay. Conclusion：laparoscopic cholecys-tectomy has lighter trauma and cause small changes of wbc, antibody comlement ,which will suit elderly people better.