腹腔镜胆囊切除术治疗老年急性坏疽性胆囊炎对机体免疫功能的影响

Effects of laparoscopic cholecystectomy on immune function of patients with senile acute gangrenous cholecystitis

目的探讨腹腔镜胆囊切除术和开腹胆囊切除术治疗老年急性坏疽性胆囊炎的疗效及其对机体免疫功能的影响。方法选择就诊治疗的急性坏疽性胆囊炎的患者120例,按照随机数字法将患者分为观察组和对照组,每组60例。对照组予以开放胆囊切除术,观察组予以腹腔镜下胆囊切除术。观察2组治疗后的手术时间,术中出血量,肛门排气时间,住院时间,视觉模拟评分(VAS),消化生存质量指数(GLQ)评分和并发症发生情况,比较2组治疗前后白介素(IL)-10、干扰素(INF)-γ、IL-2、IL-4、CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+水平的变化。结果观察组手术时间、术中出血量、肛门排气时间、住院时间、VAS评分和并发症明显短于或者少于对照组(P<0.01),GLQ评分明显优于对照组(P<0.01)。2组治疗前IL-10、INF-γ、IL-2、IL-4、CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+水平差异无统计学意义(P>0.05),治疗后2组IL-10、IL-4、CD_3^+、CD_4^+和CD_4^+/CD_8^+水平较治疗前明显降低(P<0.01),而INF-γ,IL-2和CD_8^+水平较治疗前明显升高(P<0.01),观察组治疗后IL-10、INF-γ、IL-2、IL-4、CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+水平与对照组比较,差异有统计学意义(P<0.01)。结论腹腔镜胆囊切除术治疗老年急性胆囊炎疗效确切,明显优于开胆囊切除术,对机体的炎症控制和缓解免疫漂移具有重要作用。

Objective To compare the therapeutic effects of laparoscopic cholecystectomy and open cholecystectomy on senile acute gangrenous cholecystitis ,and to observe their effects on immune function of patients .Methods One hundred and twenty elderly patients with acute gangrenous cholecystitis who were admitted and treated in our hospital from January 2012 to December 2015 were divided into observation group （ n =60 ） and control group （ n =60 ） according to random number table.The patients in control group were treated by open cholecystectomy , however, the patients in observation group were treated by laparoscopic cholecystectomy .After treatment the operation time , intraoperative hemorrhage volume , the time of passage of gas by anus , hospitalization time , visual analogue scales （ VAS） , gastrointestinal living quality index （ GLQ） and incidence rates of complications were observed and compared between two groups .Moreover the levels of interleukin （IL）-10, interferon （INF）-γ, IL-2, IL-4, CD3＋, CD4＋, CD8＋,CD4＋/CD8＋were detected and compared between two groups before and after treatment.Results The operation time, intraoperative hemorrhage volume, time of passage of gas by anus, hospitalization time, VAS and incidence rates of complications in observation group were significantly shorter or lower than those in control group （ P 〈0.01）, however, GLQ scores in observation group were superior to those in control group （ P 〈0.01）.Before treatment there were no significant differences in the levels of IL-10, INF-γ, IL-2, IL-4, CD3＋, CD4＋, CD8＋CD4＋/CD8＋between two groups （ P 〉0.05）, however,after treatment the levels of IL-10,IL-4,CD3＋,CD4＋and CD4＋/CD8＋were significantly decreased in both groups , as compared with those before treatment （ P 〈0.01 ） .Moreover there were significant differences in the levels of IL-10, INF-γ, IL-2, IL-4, CD3＋, CD4＋, CD8＋, CD4＋/CD8＋after treatment between two groups （ P 〈0.01 ）.Conclusion The laparoscopic cholecystectomy has obvious therapeutic effects on senile acute gangrenous cholecystitis,which is superior to open cholecystectomy ,which plays an important role in controlling inflammation and alleviate immunological drift .