腹腔镜手术治疗盆腔炎性包块对患者免疫功能的影响

The effect of laparoscopic surgery on immune function in patients with pelvic inflammatory mass

目的探讨手术恢复与患者机体免疫反应的相关性，阐明不同术式对盆腔炎患者预后的影响。方法选取98例在我院治疗的盆腔炎包块并接受手术治疗的患者，根据患者术式的不同，将患者分为腹腔镜手术组（n=56）与开腹手术组（n=42）。采用流式细胞仪检测T细胞亚群，酶标法测定细胞因子，记录术后恢复情况，比较两组患者以上各指标差异。结果开腹组患者术后24h、72h细胞亚群比术前显著减少（P〈0．05）；但术后72h的CD3^＋、CD8^＋有所恢复，而CD4^＋／CD8^＋则进一步降低。与术前比较，术后2h两组患者Th1细胞显著降低（P〈0．05）、Th2细胞增加（P〈0．01），Th1／Th2比值显著下降（P〈0．05）。术后2h两组患者IL—18显著降低（P〈0．01）、IL-10显著升高（P〈0．01）。开腹组术后排气时间、血象恢复时间、体温恢复时间、住院时间均显著长于腹腔镜组（P〈0．05）。结论腹腔镜手术对细胞免疫影响小、切口恢复迅速，是治疗盆腔炎包块的首选方法。

Objective To investigate the correlation between surgery recovery and immune response of patients, and clarify the effect of different surgical procedures on the prognosis of patients with pelvic inflammatory disease. Methods 98 patients with pelvic inflammatory mass treated in our hospital received surgical treatment, were divided into laparoscopic surgery group （n=56） and open surgery group （n=42） according to different surgical procedures. Detected T lymphocyte subsets with flow cytometry, cytokines with ELISA assay, recorded postoperative recovery, the indexes were compared between two groups. Results Cell subsets 24, 72 h after surgery in open surgery group significantly decreased （P〈0.05）; but CD3^＋, CD8^＋ 72 h after surgery had been restored, and CD4^＋/CD8^＋ further decreased. Th1 cells 2 h after surgery significantly decreased in both two groups （P〈0.05）, Th2 cells increased （P〈0.01）, Th1/Th2 ratio significantly decreased （P〈0.05）. IL- 18 2 h after surgery significantly decreased in both two groups （P〈0.01）, IL-10 significantly increased （P〈0.01）. Postoperative aerofluxus time, hemogram recovery time, body temperature recovery time, hospitalization time in open surgery group were significantly longer than those in laparoscopic surgery group （P〈0.05）. Conclusion Laparoscopic surgery has little effect on cellular immunity, with rapid recovery of wound, which is the first choice of treatment methods of pelvic mass.