腹腔镜胆囊切除术对机体免疫功能的影响.doc

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1、腹腔镜胆囊切除术对机体免疫功能的影响作者：李学华　隋永领　胡三元　李洪光　刘志恒　刘桂杰【摘要】　　目的：比较腹腔镜与开腹胆囊切除术对机体免疫功能的影响。方法：随机将有胆囊切除手术指征的８０例患者分为２组，腹腔镜胆囊切除组（laparoscopiccholecystectomy,ＬＣ组）和开腹胆囊切除组（opencholecystectomy,ＯＣ组）各４０例，测定并比较手术前后IgG、IgM、IgA，补体Ｃ３、Ｃ４水平及ＣＤ３＋（Ｔ细胞总数）、ＣＤ４＋（Ｔ辅助／诱导细胞）和ＣＤ８＋的数量。结果：两组IgM、IgA、Ｃ４手术前后均无明显变化，两组间差异无统计学意义。ＬＣ组术后１dIgG、Ｃ

2、３较术前有所下降，术后３d恢复至术前水平；ＯＣ组术后１dIgG、Ｃ３明显低于术前水平，术后５d恢复至术前水平；组间比较，ＯＣ组术后IgG、Ｃ３下降明显。ＬＣ组Ｔ淋巴细胞亚群手术前后差异无统计学意义，ＯＣ组术后１dＣＤ３＋、ＣＤ４＋、ＣＤ８＋与术前比较明显降低，术后５d恢复至术前水平；组间比较，术后１d、３dＯＣ组ＣＤ３＋、ＣＤ４＋、ＣＤ８＋均明显低于ＬＣ组。结论：腹腔镜手术对机体的免疫功能影响小，术后恢复快。【关键词】胆囊切除术　腹腔镜　免疫测定　Ｔ淋巴细胞　　Theinfluenceoflaparoscopiccholecystectomyonimmunefunction　　【Abstr

3、act】Ｏbjective:Tocomparetheinfluenceoflaparoscopiccholecystectomy(LC)andopencholecystectomy(OC)onimmunefunction.Methods:Eightypatientswithoperationindicationforcholecystectomyweredividedrandomlyintolaparoscopiccholecystectomy(LC,n=40)andopencholecystectomy(OC,n=40).SerumconcentrationofIgG,IgM,IgA,c

4、omplement3,4(C3,C4),aswellasperipheralbloodlevelsofCD3＋,CD4＋,CD8＋lymphocytesweremeasuredandcomparedinbothgroupspreoperativelyandpostoperatively.Results:TherewerenosignificantdifferencebetweenpreoperativeandpostoperativeconcentrationofIgA,IgMandC4inbothgroups.IgGandC3decreasedonpostoperative1stdayi

5、nLCgroup,andreturnedtothepreoperativelevelonpostoperative3rdday.IgGandC3significantlydecreasedonpostoperative1stdayinOCgroup,andreturnedtothepreoperativelevelonpostoperative5thday.ThepostoperativcIgGandC3weresingificantlylowerinOCgroupthanthoseinLCgroup.InOCgroup,thelevelsofCD3＋,CD4＋,CD8＋lymphocyt

6、esdecreasedonpostoperative1stday,andreturnedtothepreoperativelevelonpostoperative5thday.ThelevelsofCD3＋,CD4＋,CD8＋lymphocytesonpostoperative1st,3rddayinLCgroupwerelowerthanthoseinOC3group.Conclusions:LChaslessinfluenceonimmunefunctionthanOC.TheimmunefunctionofpatientswithLCcanrecovermorerapidlyafte

7、roperation.　　【Keywords】Cholecystectomy,laparoscopic;Immunefunction;Tlymphocytes２００５年１月至２００７年１月我们将８０例患者分组施行腹腔镜胆囊切除术（laparoscopiccholecystectomy，ＬＣ）与开腹胆囊切除术（opencholecystectomy,OC)，并于手术前后检测了患者的免疫球蛋白、补体及Ｔ淋巴细胞亚群，分析了