腹腔镜脾切除术对脾破裂患者白细胞介素-2、人单核细胞表面DR抗原的影响

Effect of laparoscopic splenectomy on interleukin-2 and human leukocyte antigen-DR in patients with spleen rupture

目的研究腹腔镜脾切除术对机体术后早期免疫功能的影响程度。方法将32例外伤性脾破裂患者随机分为腹腔镜脾切除术(LS)组和剖腹脾切除术(OS)组,比较两组术后外周血IL-2和单核细胞HLA-DR的含量变化。结果术前30 mim两组各指标差异均无显著性(P>0.05);IL-2:术后第1 d,两组均显著低于术前(P<0.05),但OS组下降程度明显大于LS组(P<0.05);术后第4 d,OS组较术后第1 d有所升高,但仍显著低于术前(P<0.05),LS组已恢复至术前水平(P>0.05),显著高于OS组(P<0.05)。HLA-DR:术后第l d,两组均显著低于术前(P<0.05),组间差异无显著性(P>0.05);术后第4 d,两组均有所升高,仍均显著低于术前(P<0.05),但LS组显著高于OS组(P<0.05)。结论 LS和OS对机体术后早期免疫功能均有一定程度的抑制,但LS抑制较小。

[ Objective ] To study the influence of laparoscopic splenectomy on the early postoperative immune function with traumatic spleen rupture. [Methods] 32 cases with traumatic spleen rupture were randomly divided into the laparoscopic splenectomy （LS） group and open splenectomy （OS） group. The changes of interleukin-2 （IL-2） and human leukocyte antigen-DR （HLA-DR） on the surface of mononuclear cells in peripheral blood were compared between the two groups perioperative. [ Results ] The levels of IL-2 and HLA-DR show no significant difference 30 minutes after surgery between both groups （P 〉0.05）; The level of IL-2： at first day after surgery： there were significant decreases in both groups （P〈0.05）, but the OS group level was significantly reduced relative to the LS group＇level （P 〈0.05）; At day 4 postoperative ： the OS group＇level was increased, but still significantly lower than the preoperative level （P 〈0.05）, and the LS group＇level returned to the preoperative level （P 〉0.05）, but was significantly higher than the OS group level （P 〈0.05）; The expression of HLA-DR： At first day after surgery： The levels of the two groups both were significant decreased relative to the preoperative levels （P 〈0.05）, but had no significant difference between groups （P 〉0.05）; At the fourth day postoperative： the levels of the two groups both were increased, but the LS group＇level was significantly higher than the OS group＇levcl （P 〈0.05）. [Conclusion] The LS and OS both have a certain degree of inhibition on the immune function of early postoperative body, but the LS caused inhibition is smaller.