手助腹腔镜与开腹脾切除加门奇断流术对机体免疫功能和创伤反应影响临床研究

EFFECT OF HAND ASSISTANT LAPAROSCOPIC SPRENECTOMY PLUS PERICARDIAL DEVUSCULURIZATION AND OPEN SURGERY ON IMMUNE SYSTEM AND WOUND RESPONSES

目的 :研究手助腹腔镜和开腹脾切除加门奇断流两种术式对机体免疫功能及创伤反应的影响 ,探讨其差异及新术式的可行性。方法 :监测 5 0例 (手助腹腔镜及开腹各 2 5例 )肝硬变、门静脉高压症患者术前、术后第1天 ,术后第 3天的外周血淋巴细胞 (PBL)亚群、C -反应蛋白 (CRP)、白细胞介素 6 (IL - 6 )和肿瘤坏死因子(TNF)的变化并进行对比研究。结果 :开腹组术后第 3天成熟的T淋巴细胞 (CD3 )、辅助性T细胞 (CD4)、CD4与抑制性T淋巴细胞 (CD8)比值较术前明显下降 (P <0 .0 5或P <0 .0 1)。且两组相比较开腹组明显低于手助腹腔镜组 (P <0 .0 1)。开腹组术后第 1天或 /和术后第 3天CRP、IL - 6、TNF较术前明显升高 (P <0 .0 1)。且两组比较开腹组明显高于手助腹腔镜组 (P <0 .0 1)。结论 :手助腹腔镜组对机体免疫及细胞因子水平影响较小 ,这构成手助腹腔镜组脾切除加断流术术后恢复较快及创伤反应小的病理、生理基础 ,同时也证明了该新术式治疗肝硬变、门静脉高压症的可行性及优越性。

Objective:The consequence of hand assistant laparoscopic splenectomy plus pericardial devascularization and open splenectomy plus pericardial devascularization exerted on human immune system and wound responses.Discuss the difference of them and feasibility of new operation.Methods:Multiple immunoassays were testeded compared postoperatively in each of 25 patients after hand assistant laparoscopic splenectomy plus pericardial devascularization or open splenectomy plus pericardial devascularization under complete anesthesial. Results:Postoperative level of CD_3 CD_4 and CD_4/CD_8 in have had open splenectomy plus perical devascularization decreased significantly than those undergoing hand assistant laparoscopic splenectomy plus pericardial devscularization ( P <0.05)and( P <0.01) whereas the interleukin-6 (IL-6 ) and tumor necosis factor(INF) of the foemer increased evidently ( P <0.01) than the latter .Conclusions:It is suggested that hand assistant laparoscopic splenectomy plus pericardial devascularization impose less influences on immunoassays , cytokin and wound responses.It is prove that hand assistant laparoscopic splenectomy plus pericardial devascularization is effective in the treatment of portal hypertension due to cirrhosis.