胆囊结石患者腹腔镜微创术后外周血T细胞亚群、免疫球蛋白和IL-6及TNF-α的变化

Effect of Laparoscopic Minimally Invasive Surgery on Peripheral Blood T Cell Subset,Immunoglobulin and IL-6、TNF-α in Patients with Gallbladder Stones

目的:探讨腹腔镜微创手术对胆囊结石患者术后外周血T细胞亚群、免疫球蛋白和炎症介质的影响。方法:胆囊结石患者68例,随机均为对照组、实验组,各34例;对照组采用小切口手术治疗,实验组采用腹腔镜微创手术治疗,比较两组患者的手术时间、术中出血量及下床活动时间等一般情况;观察两组患者术前和术后第1、5天时的白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)水平变化;检测两组患者术前和术后第1、5天时的T淋巴细胞亚群CD3+及CD4+、免疫球蛋白G、A、M(IgG、IgA、IgM)水平,随访两组患者术后6个月胆囊结石复发率和并发症发生率。结果:实验组手术时间及下床活动时间较对照组明显短,术中出血量较对照组明显少,差异有统计学意义(P<0.05);与术前相较,术后第1天两组患者的IL-6、TNF-α明显升高,CD3^+、CD4^+、IgG、IgA、IgM明显降低,但术后第5天仅对照组IL-6、TNF-α明显升高,CD3^+、CD4^+、IgG、IgA、IgM明显降低,且术后对照组各项指标变化幅度较实验组明显大,差异有统计学意义(P<0.05);术后实验组胆囊结石复发率2.94%、并发症总发生率14.71%较对照组17.65%、35.29%明显低,差异有统计学意义(P<0.05)。结论:腹腔镜微创手术治疗胆囊结石,对患者术后外周血T细胞亚群、免疫球蛋白和炎症介质水平的影响较小,同时明显降低患者术后胆囊结石的复发率。

Objective： To investigate the effect of effect of laparoscopic minimally invasive surgery and small incision surgery on peripheral blood T cell subset,IgG and IL-6 in patients with gallbladder stones. Methods： 68 patients with gallbladder stones were randomly divided into the control group and experimental group in equal number. The control group were treated by small incision surgery while the experimental group were treated by laparoscopic minimally invasive surgery. Comparing the surgical time,intraoperative blood loss and ambulation time between the two groups. Changes in levels of interleukin-6（ IL-6） and tumor necrosis factor α（ TNF-α） in both groups before surgery and on the 1 st and 5 th day after surgery were observed. Levels of T cell subsets CD3~＋and CD4~＋,immunoglobulin G（ IgG）,immunoglobulin A（ IgA） and immunoglobulin M（ IgM） ]in both groups were detected before surgery and on the 1^（st） and 5^（th） day after surgery. The recurrence rate of gallbladder stones and the incidence of complications in both groups six months after surgery were recorded. Results： The surgical time,ambulation time and intraoperative blood loss of the experimental group were shorter and less than those of the control group,differences were statistically significant（ P〈0. 05）. On the 1 st day after surgery,IL-6 and TNF-α were increased significantly while CD3~＋,CD4~＋,IgG,IgA and IgM were decreased significantly in both groups; while on the 5 th day after surgery,IL-6 and TNF-α were increased significantly while CD3~＋,CD4~＋,IgG,IgA and IgM were decreased significantly only in the control group,and the range of variation of control group after surgery was more obvious than experiment group,differences were statistically significant（ P〈0. 05）. The recurrence rate of gallbladder stones was 2. 94%,the total incidence of complications was 14. 71% in the experimental group,which were lower than those of control group（ 17. 65% and 35. 29%）,differences were statistically significant（ P〈0. 05）. Conclusion： Laparoscopic minimally invasive surgery has relatively less effect on T cell subsets,immunoglobulins and inflammatory mediators in peripheral blood,and it can significantly reduce the recurrence rate of gallbladder stones after surgery.