腹腔镜辅助微创肝胆外科手术对患者免疫系统的影响

Effect of laparoscopic-assisted minimally invasive hepatobiliary surgery on the immune system of patients

目的探讨腹腔镜辅助微创肝胆外科手术对患者免疫系统的影响。方法80例微创肝胆外科手术患者,依据术式不同分为开腹手术组和腹腔镜手术组,每组40例。开腹手术组患者采用传统开腹手术进行治疗,腹腔镜手术组患者采用腹腔镜辅助微创肝胆外科手术进行治疗。比较两组患者手术时间、术中出血量、疼痛评分、术后并发症发生情况,手术前后免疫功能指标(CD3^(+)CD4^(+)/CD3^(+)CD8^(+)、CD3-CD16^(+)CD56^(+))水平。结果腹腔镜手术组患者的手术时间显著长于开腹手术组,术中出血量显著少于开腹手术组,疼痛评分和术后并发症发生率均显著低于开腹手术组,差异具有统计学意义(P<0.05)。腹腔镜手术组患者手术前的CD3^(+)CD4^(+)/CD3^(+)CD8^(+)、CD3-CD16^(+)CD56^(+)分别为(2.04±0.61)%、(18.00±2.50)%,手术后分别为(1.53±0.38)%、(16.20±3.60)%;开腹手术组患者手术前的CD3^(+)CD4^(+)/CD3^(+)CD8^(+)、CD3-CD16^(+)CD56^(+)分别为(2.10±0.52)%、(18.50±2.60)%,手术后分别为(1.73±0.35)%、(14.50±2.60)%。手术前,两组患者的CD3^(+)CD4^(+)/CD3^(+)CD8^(+)、CD3-CD16^(+)CD56^(+)比较,差异无统计学意义(P>0.05);手术后,两组患者的CD3^(+)CD4^(+)/CD3^(+)CD8^(+)、CD3-CD16^(+)CD56^(+)均较手术前显著降低,腹腔镜手术组患者的CD3^(+)CD4^(+)/CD3^(+)CD8^(+)降低幅度显著高于开腹手术组,CD3-CD16^(+)CD56^(+)降低幅度显著低于开腹手术组,差异具有统计学意义(P<0.05)。结论腹腔镜辅助微创肝胆外科手术较开腹手术对患者的免疫系统的影响小。

Objective To discuss the effect of laparoscopic-assisted minimally invasive hepatobiliary surgery on the immune system of patients.Methods A total of 80 patients with minimally invasive hepatobiliary surgery were divided into open surgery group and laparoscopic surgery group according to different surgical methods,with 40 cases in each group.Patients in the open surgery group were treated with traditional open surgery,and patients in the laparoscopic surgery group were treated with laparoscopic-assisted minimally invasive hepatobiliary surgery.The operation time,intraoperative blood loss,pain score,postoperative complications,and levels of immune function indexes(CD3^(+)CD4^(+)/CD3^(+)CD8^(+),CD3-CD16^(+)CD56^(+))before and after surgery were compared between the two groups.Results The operation time of the laparoscopic surgery group was significantly longer than that of the open surgery group,the intraoperative blood loss was significantly less than that of the open surgery group,and the pain score and postoperative complication rate were significantly lower than those of the open surgery group.All the differences were statistically significant(P<0.05).In the laparoscopic surgery group,the CD3^(+)CD4^(+)/CD3^(+)CD8^(+)and CD3-CD16^(+)CD56^(+)were(2.04±0.61)%and(18.00±2.50)%before surgery,and(1.53±0.38)%and(16.20±3.60)%after surgery;in the open surgery group,the CD3^(+)CD4^(+)/CD3^(+)CD8^(+)and CD3-CD16^(+)CD56^(+)were(2.10±0.52)%and(18.50±2.60)%before surgery,and(1.73±0.35)%and(14.50±2.60)%after surgery.Before surgery,there was no statistically significant difference in CD3^(+)CD4^(+)/CD3^(+)CD8^(+)and CD3-CD16^(+)CD56^(+)between the two groups(P>0.05).After surgery,the CD3^(+)CD4^(+)/CD3^(+)CD8^(+),CD3-CD16^(+)CD56^(+)in both groups were significantly lower than those before surgery in this group;the decrease of CD3^(+)CD4^(+)/CD3^(+)CD8^(+)in the laparoscopic surgery group was significantly higher than that in the open surgery group,and the decrease of CD3-CD16^(+)CD56^(+)was significantly lower than that in the open surgery group;all the differences were statistically significant(P<0.05).Conclusion Laparoscopic-assisted minimally invasive hepatobiliary surgery has less impact on the patient’s immune system than open surgery.