后腹腔镜与开放性输尿管切开取石术对患者免疫功能影响的比较

Comparison of Immune Functions Between Retroperitoneal Laparoscopic Ureterolithotomy and Open Surgery

目的比较后腹腔镜与开放性输尿管切开取石术对患者免疫功能的影响。方法回顾性分析我院2013年6月~2015年4月96例输尿管上段结石的临床资料,依据手术方式分为后腹腔镜组50例和开放组46例,比较2种手术方式对机体围手术期免疫功能(包括体液免疫指标IgA、IgG、IgM和细胞免疫指标T细胞CD^(3+)、CD^(4+)、CD^(8+)、CD^(4+)/CD^(8+))的影响。结果后腹腔镜组体液免疫指标IgA、IgG、IgM术后2 h、1 d、7 d与术前2 h比较均无统计学差异(P>0.05),开放组IgG术后1 d与术前2 h比较明显下降(P<0.05),术后7 d恢复至术前水平(P>0.05);2组术后1 d IgA、IgG有统计学差异(P<0.05),但其他时点IgA、IgG均无统计学差异(P>0.05);2组IgM术后各时间点与术前2 h比较无统计学差异(P>0.05)。2组细胞免疫指标T细胞CD^(3+)、CD^(4+)、CD^(8+)、CD^(4+)/CD^(8+)术后2 h、1 d与术前2 h比较均明显下降(P<0.05),CD^(3+)、CD^(4+)、CD^(8+)和CD^(4+)/CD^(8+)术后7 d恢复至术前2 h水平(P>0.05);术后2 h、1 d后腹腔镜组上述指标明显低于开放组(P<0.05),但术后7 d 2组差异无统计学意义(P>0.05)。结论后腹腔镜输尿管切开取石术对机体免疫功能的抑制小于传统开放手术。

Objective To compare effects of immune functions between retroperitoneal laparoscopic ureterolithotomy and open surgery. Methods We analyzed clinical data of 96 patients with upper ureteral calculus from June 2013 to April 2015 in our hospital. The patients were divided into either retroperitoneal laparoscopic ureterolithotorny group （50 eases） or open surgely group （46 cases） according to the operation they received. The effects of operative therapy on immune functions （including humoral immune index IgA, IgC, IgM and cellular immune index CD3＋ , CD4＋ , CD3＋ , CD4 ＋/CD8＋ ） were compared during the perioperative period. Results The IgA, IgG and lgM levels in the retroperitoneal laparoscopic group didn＇ t not significantly change at 2 h, 1 d, and 7 d postoperatively as compared with preoperative level （P 〉 0.05 ）. The IgC level in the open surgery group significantly decreased （ P 〈 0.05） at 1 d postoperatively than before treatment, and returned to preoperative level （P 〉 0.05） at 7 d after surgery. The IgA and IgC levels of the two groups were significantly different at 1 d after surgery （P 〈 0.05） , and showed no difference at the other time points （P 〉 0.05）. The IgM levels at all the time points showed no difference between the two groups （P 〉 0.05）. The CD3 ＋ , CD4 ＋ , CD3 ＋ , and CD4 ＋/CDs ＋ levels of the two groups significantly decreased at 2 h and 1 d after surgery than before treatment （P 〈 0.05） , and returned to preoperative level at 7 d after surgelT （P〉0.05）. The CD3 ＋ , CD4 ＋ , CD8 ＋ , and CD4 ＋/CD8 ＋ levels at2 h and 1 d after surgery decreased more obviously in the open surgery group than those in the retroperitoneal laparoscopie group, with significantly different （ P 〈 0. 05 ） , but had no difference （ P 〉 0. 05 ） at 7 d after surgery. Conclusion Retroperitoneal laparoscopic ureterolithotomy has less immunosuppression effects than the traditional open surgery.