腹腔镜胆囊切除术对患者免疫功能、应激和肝功能的影响

Effect of laparoscopic cholecystectomy on immune function,stress and liver function in patients

目的:探讨腹腔镜胆囊切除术对患者的免疫功能、应激和肝功能的影响。方法:选取我院肝胆外科住院行胆囊切除术的胆囊良性病变患者168例,分为腔镜胆囊切除术组113例,开腹胆囊切除术组55例,并于术前1 d、术后1、3、9 d分别抽取清晨空腹静脉血检测免疫功能、应激和肝功能。结果:免疫功能指标CD3^+、CD4^+、IgG、IgM、IgA术后1 d均降低,术后3 d均开始升高,术后9 d均恢复到术前1 d水平,CD8^+术后1 d升高,术后3 d开始降低,术后9 d恢复到术前1 d水平;腔镜胆囊切除术组CD3^+、CD4^+、IgG、IgM术后1 d降低幅度均小于开腹胆囊切除术组(P<0.05),术后3 d升高幅度均高于开腹胆囊切除术组(P<0.05),CD8^+术后3 d降低幅度高于开腹胆囊切除术组(P<0.05),IgA术后3 d升高幅度均高于开腹胆囊切除术组(P<0.05)。应激指标IL-6、TNF-α、CRP术后1 d均升高,IL-6、CRP术后3 d均降低,其中仅IL-6术后9 d恢复至术前1 d水平,TNF-α术后9 d降低,但仍高于术前1 d水平;腹腔镜胆囊切除术组IL-6、TNF-α、CRP变化幅度均小于开腹胆囊切除术组(P<0.01)。肝功能指标ALT、TBIL、AST术后1 d均升高,术后3 d均降低,术后9 d恢复至术前1 d水平;腹腔镜胆囊切除术组ALT、TBIL、AST变化幅度均小于开腹胆囊切除术组(P<0.01)。结论:腹腔镜胆囊切除术对患者的免疫功能、应激和肝功能的影响比开腹胆囊切除术小,可以作为首选的手术方式。

Objective： To explore the effect of laparoscopic cholecystectomy on the immune function, stress and liver function in patients. Methods：One hundred sixty-eight cases of benign lesions of gallbladder in the Department of hepatobiliary surgery of our hospital were selected, divided into 113 cases of laparoscopic cholecystectomy group,55 cases of open cholecystectomy group, early morning fasting venous blood were taken 1 d before the operation, 1 d,3d and 9d after the operation to detect the immune function, stress and liver function. Results： CD3 ＋, CD4 ＋, IgG, IgM, IgA were all decreased l d after the operation, 3 d after the operation began to increase, and 9 d all recovered to 1 d before the operation, CD8 ＋ was increased 1 d after the operation, 3 d was reduced, and 9 d was restored to 1 d before the operation; CD3 ＋, CD4＋, IgG, IgM in laparoscopic cholecystectomy group reducted less than open cholecystectomy group 1 d after the operation（ P 〈 0.05 ）, increased higher than open cholecystectomy group 3d after the operation（P 〈 0.05 ）, The reduction rate of CD8 ＋ was higher than that in open cholecystectomy group 3 d after the operation （ P 〈 0.05 ）, the increase IgA was higher than that in open cholecystectomy group 3d after the operation（P 〈 0.05 ）. Stress indexes IL-6, TNF-αand CRP were all increased ld after the operation, IL-6,TNF-awere all decreased 3 d after the operation, only IL-6 recovered to 1 d before the operation, TNF-α decreased after 9 d after the operation; The changes of IL-6, TNF-αand CRP in laparoscopic cholecystectomy group were significantly lower than that in open cholecystectomy group（P 〈 0.01 ）. Liver function indexes ALT, TBIL and AST were all increased 1 d after operation, decreased 3 d after operation, and 9 d recovered to 1 d before the operation;The changes of ALT,TBIL and AST in laparoscopic cholecystectomy group were significantly lower than that in open cholecystectomy group （P 〈 0.01 ）. Conclusions： The effect of laparoscopie cholecystectomy on the immune function, stress and liver function of the patients are smaller than that of open cholecystectomy, and it can be the first choice of operation.