对肝硬化门静脉高压症患者应激和免疫功能的影响

Effects of laparoscopic splenectomy and esophagogastric devascularization on stress and immune function in patients with cirrhotic portal hypertension

目的评估腹腔镜脾切除联合贲门周围血管离断术对肝硬化门静脉高压患者应激和免疫功能的影响。方法回顾性分析2015年6月至2017年6月河南省人民医院66例肝硬化门静脉高压症患者的临床资料,分为腹腔镜脾切除联合断流术(laparoscopic splenectomy and pericardial devascularization, LSPD )组 29 例和开腹脾切除联合断流术(open splenectomy and pericardial devascularization,OSPD)组37例。结果 LSPD组血浆皮质醇浓度低于OSPD组(F分组=18. 85,P = 0.020),两组皮质醇的浓度随时间的延长先升高后降低(F时间=532.08 ,P = 0.000),LSPD组升高后降低的幅度大于OSPD组(F交互=24. 91 ,P =0. 000)。LSPD组CD3 +、CD4 *、CD4 +/CD8 +水平高于 OSPD 组,CD8 +水平低于 OSPD 组(F 分组=3.55,21. 47 J 54. 84,64. 29,P <0. 05),两组 CD3 +、CD4+、CD4+/CD8*的水平随时间的延长先降低后升高,CD8+先升高后降低(F时间=199.22、298. 48 ,864. 33,510. 23,P<0.05),LSPD 组 CD3 +、CD4+、CD4 +/CD84 降低后升高的幅度、CD8 +升高后降低的幅度大于OSPD组(F交互=19. 27、1& 21、79. 55、35. 21 ,P <0. 05)。两组在术后再出血、血栓形成、胃或食管屡、胰痿等方面差异无统计学意义(X2=0- 05,0. 67.0.07,0. 16,P = 0. 829,0.413.0. 789.0.693),但OSPD组术后胸腔、腹腔积液和术后脾热(体温〉38. 0℃,>3 d)情况较LSPD组严重&2=5.49、6.68』=0.019、0.010)。结论LSPD可以有效降低肝硬化门静脉高压症患者术后应激反应,促进免疫功能恢复,降低术后胸腔、腹腔积液和术后脾热的发生率。

Objective To evaluate the effects of laparoscopic splenectomy and esophagogastric devascularization( LSPD) vs. open procedure( OSPD) on stress and immune function in patients with portal hypertension due to cirrhosis. Methods From June 2015 to June 2017 a total of 66 patients underwent LSPD or OSPD procedures. Results Plasma cortisol concentration in the LSPD group was lower than that in the OSPD group ( Fgroup = 18. 85 ,P =0. 020). Cortisol concentration in the two groups increased firstly and then decreased with time extension ( Ftime = 532. 08 , P = 0. 000 ). The level of CD3 +, CD4+, CD4 +/CD8 + in LSPD group was higher than that in OSPD group, and the level of CD8 + was lower than that in OSPD group ( Fgroup = 3. 55,21. 47, 154. 84,64. 29, P V 0. 05 ), the levels of CD3 +, CD4+ and CD4 +/CD8 + in the two groups first decreased and then increased with the extension of time, and the levels of CD8 + increased firstly and then decreased( Ftime = 199. 22, 29& 48, 864. 33, 510. 23 ,P < 0. 05 ), the increase range of CD3 +, CD4 +, and CD4 +/CD8 + in LSED group was higher than that in OSPD group (Finteraction = 19. 27 , 1& 21, 79. 55 , 35. 21, P V 0. 05 );there was no statistical significance in the complications such as: rebleeding, thrombosis and splenic fever in the two groups(x2 = 0. 05 , 0. 67 , 0. 07, 0. 16, P = 0. 829, 0. 413, 0. 789, 0. 693 ). But the postoperative chest/cavity effusion and fever (>38.0℃ and >3 days) is OSPD group is higher than in the LSPD group(x2=5. 49, 6. 68,P =0. 019, 0. 010). Conclusion LSPD effectively reduces postoperative stress, protects immune function ,decreases postoperative pleural and abdominal effusion and fever.