腹腔镜与开腹胆囊切除术对腹腔免疫功能影响的比较

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1、腹腔镜与开腹胆囊切除术对腹腔免疫功能影响的比较作者：于建军，陆国超，李春雨，吴远冰【关键词】,腹腔镜　　摘要：目的：比较腹腔镜与开腹胆囊手术对腹腔局部免疫功能的影响。方法：检测一组31例腹腔镜胆囊切除术患者(A组)和一组33例开腹胆囊切除术患者(B组)腹腔内渗液pH值、腹腔中性粒细胞吞噬功能、巨噬细胞产生TNFα生物学活性、腹腔T细胞亚群CD4+/CD8+的比值，并采用T检验比较两组各项指标的差异。结果：A组和B组腹腔pH值分别为7.13和7.39；中性粒细胞化学发光峰值为分别为98和102；L929细胞OD570值分别为0.183和0.152；CD4+/CD8+比值分别

2、为0.53和0.57。除CD4+/CD8+比值外，其余三项指标的差异均有显著性。结论：与开腹胆囊切除术比较，腹腔镜胆囊切除术对腹腔局部免疫特别是细胞免疫有明显的抑制效应。此种免疫抑制效应源于CO2气腹所引起的局部内环境的酸性化，对巨噬细胞功能的影响犹为显著。胆囊有急性炎症者应慎行腹腔镜胆囊切除术。　　关键词：胆囊切除术；氢离子浓度；白细胞吞噬；肿瘤坏死因子α；T淋巴细胞亚群9　　ComparetheInfluenceofLaparoscopicandOpenCholecystectomyontheImmuneFunctionoftheLocalPeritonealCavi

3、ty　　Abstract：Objective：Tocomparetheinfluenceoflaparoscopicandopencholecystectomyontheimmunefunctionofthelocalperitonealcavity.Method：DeterminationofthepHvalue,phagocyticfunctionofneutrophils,thebiologicalviabilityofTNFαproducedbymacrophagesandtheTlymphocytessubsetsCD4+/CD8+ratiooftheperit

4、onealcavityinagroupof31caseswhounderwentlaparoscopiccholecystectomyandinanothergroupof33caseswhounderwentopencholecystectomy.WeusedTtesttocomparethedifferenceofthese4indexesbetweenbothgroups.Result：Ofthesetwogroups,theaveragepHvaluewere7.13and7.39respectively;Themeanpeakvalueofchemilumine

5、scencewas98and102respectively;themeanOD570ofL929Cellswas0.183and0.152respectively;andtheCD4+/CD8+ratiowas0.53and0.57respectively.ExceptfortheCD4+/CD8+ratio,thedifferenceoftheother3indexesbetweenbothgroupswereofsignificance.Conclusion：Comparedtoopensurgery,laparoscopiccholecystectomyhasobv

6、iousdepressiveeffectsontheimmunefunctionsparticularlycell-mediatedimmunefunction9ofthelocalperitonealcavity.SuchimmunedepressiveeffectsoriginatefromtheacidificationoftheintraperitonealenvironmentcausedbyCO2pneumoperitoneum,andaremoreevidentonmacrophages.Therefore,laparoscopiccholecystecto

7、myonpatientswithacuteinflammationofthegallbladdershouldbeverycautious.　　Keywords：Cholecystectomy;Hydrogenionconcentration;Neutrophilphagocytic;Tumornecrosisfactorα;Tlymphocytessubset　　尽管腹腔镜手术对全身免疫功能影响较小已是定论，腹腔镜手术对腹腔免疫功能的影响目前仍未明确。自2005年4月至2005年11月，我们在收治的腹腔镜胆囊切除术患者和开腹