腹腔镜手术对盆腔炎性包块患者的T淋巴细胞免疫功能及术后恢复的影响

Effects of laparoscopic surgery for pelvic inflammation mass resection on cellular immune function of T-lymphocyte subsets and postoperative recovery

目的探讨腹腔镜与开腹手术治疗盆腔炎性包块对机体细胞免疫功能及术后恢复的影响。方法选择2008年1月至2013年1月在宜昌市中心人民医院就诊并诊断为盆腔炎性包块的56例患者为研究对象,平均年龄为(33±12)岁。按照不同手术类型,将其分为腹腔镜组(n=32,接受腹腔镜手术)和对照组(n=24,接受开腹手术)。于术前及术后2,24,72h分别抽取肘静脉血10mL,并进行以下测定。1采用荧光激活细胞分拣术(FACS)测定T淋巴细胞亚群CD3、CD4和CD8,同时测定辅助性T淋巴细胞(Th)1,Th2水平,并对两组间各亚群以及Th1、Th2和Th1/Th2的差异进行统计学分析。2酶联免疫吸附测定(ELISA)法测定两组患者血清白细胞介素(IL)-18,-10的水平。3术后恢复情况观察指标:肠道排气时间、体温恢复到正常时间、血常规恢复时间、住院时间等(本研究遵循的程序符合宜昌市中心人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象的知情同意,并与之签署临床研究知情同意书)。结果结果 1腹腔镜组患者T淋巴细胞亚群CD3、CD4、CD8于术前及术后2,24,72h比较,差异无统计学意义(t=1.83,1.69,t=1.74;P>0.05)。开腹组术后24,72h时CD3、CD4、CD8水平均较术前显著降低,并且差异有统计学意义(术后24h:t=2.38,2.47,2.45;P<0.05;术后72h:t=2.41,2.46,2.56;P<0.05)。开腹组术后2,24h的CD3、CD4、CD8水平显著低于腹腔镜组,并且差异有统计学意义(术后2h:t=2.56,2.61,2.69;P<0.05;术后24h:t=2.61,2.69,2.78;P<0.05);但两组术后72h时CD3的水平比较,差异无统计学意义(t=1.68,P>0.05)。2两组患者术后2hTh1减少、Th2增加,Th1/Th2水平下降,与术前比较,差异均有统计学意义(腹腔镜组:t=2.23,7.35,7.15;P<0.05;开腹组:t=9.45;7.18,8.56;P<0.01)。但术后24h腹腔镜组Th1、Th2、Th1/Th2即恢复至术前水平,并且差异无统计学意义(t=1.82,1.38,1.72;P>0.05)。3两组患者术后2hIL-18水平降低,IL-10水平升高,与术前比较,差异均有统计学意义(腹腔镜组:t=6.98,8.87;P<0.01;开腹组:t=10.17,7.18;P<0.01);但术后24h腹腔镜组IL-18,-10水平即恢复至术前,并且差异无统计学意义(t=1.78,1.89;P>0.05)。4两组患者的术中出血量、术后排气时间、体温恢复到正常时间、血常规恢复时间及住院时间比较,差异均有统计学意义(t=6.34,12.38,15.32,2.37,7.15;P<0.05),而两组患者的手术时间、住院总费用、手术费用、抗菌药物使用时间比较,差异无统计学意义(t=1.37,1.67,1.35,1.87;P>0.05)。结论盆腔炎性包块切除术后细胞免疫功能紊乱可能影响术后恢复。腹腔镜下行盆腔炎性包块切除术对T细胞亚群及机体细胞免疫影响小,且Th1/Th2平衡恢复快。

Objective To discuss effects of laparoscopic surgery for pelvic inflammation mass resection on cellular immune function of T lymphocyte and postoperative recovery. Methods A total of 56 patients with pelvic inflammation mass were admitted into Yichang Central People＇s Hospital from January 2008 to January 2013. Their average age was （33±12） years old. They were divided into two groups according to different surgery types, laparoscopy group （n=32） and open surgery group （n=24）. Thepreoperation blood sample and 2, 24, 72 h after operation blood sample were collected from every subjects. ①T-lymphocyte subsets CD3 ,CD4 and CD8 were detected by flow cytometry （FCM）, at the same time, helper T-lymphocyte （Th）1, Th2 were also detected. ②The levels of IL-18, -10 were detected by enzyme linked immunosorbent assay （ELISA）. ③ The observation items after operation including intraoperative blood loss, postoperative exhaust time, duration of temperature back to normal, duration of complete blood count back to normal and hospitalization, duration of operation, hospitalization expense, operation expense and duration of antimierobial use. The study protocol was approved by the Ethical Review Board of Yichang Central Peoplets Hospital. Informed consent was obtained from the every participates. Results ① There were no significant differences on T-lymphocyte subsets CD3, CD4, CD8 between preoperation and 2, 24, 72 h after operation in laparoscopy group （t= 1. 83,1. 69,1. 74;P〉0. 05）. The levels of T-lymphocyte subsets CD3 ,CD4, CDa at 24, 72 h after operation were lower than those of preoperation, with significant differences （24 h after operation：t=2.38,2.47,2.45; P〈0.05; 72 h after operation： t=2.41,2.46,2.56; P〈00.05）. The levels of T-lymphocyte subsets CDa ,CD4 ,CDa at 2, 24 h postoperation in open surgery were significant lower than those of laparoscopy group （2 h after operation： t= 2.56,2.61,2.69 ; P〈0.05 ; 24 h after operation：t=2.61,2.69,2.78;P〈0.05）. But there were no significant difference on CD3 at 72 h after operation between two groups （t=1. 68,P〉0. 05）. ②The levels of Thl, Thl/Th2 decreased and Th2 increased at 2 h after operation, and there were significant differences of Thl, Th2 and Thl/Th2 at 2 h after operation between two groups （laparoscopy group： t=2.23,7.35,7.15;P〈0.05;open surgery group： t= 9.45 ; 7.18,8.56 ; P〈0.01）. And the levels of Thl, Th2 and Thl/Th2 of laparoscopy group back to normal at 24 h after operation, there were no significant differences on the levels of Thl, Th2 and Thl/Th2 in laparoscopy group between preoperation and 24 h after operation （t=1.82, 1. 38, 1. 72; P〉0. 05）. ③Compared with preoperation, the levels of IL-18 decreased and IL-10 increased at 2 h after operation in both two groups （ laparoscopy group ： t = 6. 98,8. 87 ; P〈 0.01 ; open surgery group ： t = 10.17,7. 18; P〈0.01 ）. The levels of IL-18, -10 back to normal at 24 h after operation, and there were significant differences on IL-18, 10 between preoperation and 24 h after operation in laparoscopy group （t = 1. 78,1.89; P 0.05）. ④There were significant differences on intraoperative blood loss, postoperative exhaust time, duration of temperature back to normal, duration of complete blood count back to normal and hospitalization between two groups （t=6.34,12.38,15.32,2.37,7.15;P〈.05）. There were no significant differences on duration of operation, hospitalization expense, operation expense and duration of antimicrobial use between two groups （t = 1.37,1.67,1.35,1.87; P〉0.05）. Conclusions Cellular immune dysfunction of post-pelvic inflammatory disease may be involved in post-operative recovery. Laparoscopic surgery for pelvic inflammation mass resection had little influence on T cell subsets, body＇s cellular immune, and the Thl/Th2 balance back to normal soon.