经皮经肝胆囊穿刺联合腹腔镜手术治疗急性重症胆囊炎的术后应激反应程度和免疫应答状态评估

Evaluation of the stress response and immune response after percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery for acute severe cholecystitis

目的:研究经皮经肝胆囊穿刺联合腹腔镜手术治疗急性重症胆囊炎的术后应激反应程度和免疫应答状态。方法:选择在本院接受手术治疗的86例急性重症胆囊炎患者作为研究对象,随机分为两组,观察组接受经皮经肝胆囊穿刺联合腹腔镜手术治疗、对照组患者接受急诊腹腔镜手术治疗,术后当天及术后3天时,采集血清并检测炎症反应指标、应激反应指标及免疫应答指标。结果:观察组患者术后当天及术后3天时血清中HMGB-1、IL-2、IL-6、hs-CRP、ET-1、ACTH、Cor、MDA的含量以及外周血中CD8+的含量均显著低于对照组,血清中SOD、IgG、IgM、IgA的含量以及外周血中CD3+、CD4+的含量显著高于对照组。结论:经皮经肝胆囊穿刺联合腹腔镜手术治疗急性重症胆囊炎能够改善术后炎症反应、应激反应及免疫应答。

Objective： To study the stress response and immune response after percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery for acute severe eholecystitis. Methods： A total of 86 patients with severe acute cholecystitis who received surgical treatment in Yulin Second Hospital were selected as the research subjects and randomly di- vided into two groups, observation group of patients received percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery, control group of patients received emergency laparoscopic surgery, and serum was collected the same day and 3 days after operation to determine the inflammation indexes, stress response indexes and immune response indexes. Re- suits： The same day and 3 days after operation, serum HMGB-1, IL-2, IL-6, hs-CRP, ET-1, ACTH, Cor and MDA levels as well as peripheral blood CD8＋ levels of observation group were significantly lower than those of control group, while serum SOD, IgG, IgM and IgA levels as well as peripheral blood CD3＋ and CD4＋ levels of observation group were significantly higher than those of control group. Gonclusion： Percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery for acute severe cholecystitis can improve the postoperative inflammatory response, stress response and immune response.