摘要
目的探讨腹腔镜筋膜内子宫切除术(c lassical intrafasc ial supracervical hysterectomy,C ISH)对机体免疫功能的影响。方法选择因良性疾病须行子宫切除术60例,随机分为2组,每组各30例,分别行C ISH和开腹子宫切除术(abdom inal hysterectomy,AH)。测定2组术前、术后1 d血白细胞计数、中性粒细胞百分数,术前1 d和术后1 d、4 d外周血淋巴细胞亚群(CD3、CD4、CD8)、IL-2、IL-10水平。结果2组术后1 d外周血CD3、CD4浓度较术前均有不同程度的下降(C ISH组:qCD3=6.033,qCD4=4.763;AH组:qCD3=11.043,qCD4=9.202;P<0.05),但AH组上述指标显著低于C ISH组(tCD3=4.509,PCD3=0.000;tCD4=2.494,PCD4=0.016),术后4 d C ISH组CD3、CD4与术前无显著差异(qCD3=1.046,qCD4=0.238,P>0.05),AH组仍明显低于术前(qCD3=6.531,qCD4=5.269,P<0.05),2组比较差异有显著性(tCD3=4.251,PCD3=0.000;tCD4=3.389,PCD4=0.001);2组CD8浓度术后均稍有下降,但无统计学意义(C ISH组:F=0.98,P=0.379;AH组:F=0.29,P=0.752)。C ISH组术后1 d、4 d外周血IL-10较术前无明显升高(F=2.24,P=0.113),而AH组术后明显升高(q1-2=20.182,q1-3=15.933,P<0.05),2组比较差异有显著性(术后1 dt=-11.632,P=0.000;术后4 dt=-7.745,P=0.000)。外周血IL-2浓度:C ISH组术后1 d明显降低(q=5.465,P<0.05),术后4 d与术前相比差异无显著性(q=2.484,P>0.05),AH组术后1 d、4 d较术前均明显降低(q1-2=11.187,q1-3=5.404,P<0.05),2组间差异有显著性(术后1 dt=5.281,P=0.000;术后4 dt=2.806,P=0.007)。AH组术后1 d血WBC和中性粒细胞百分数明显升高(t=-17.476,P=0.000;t=-16.851,P=0.000),C ISH组亦明显高于术前(t=-10.685,P=0.000;t=-9.624,P=0.000),2组比较差异有显著性(t=-7.020,P=0.000;t=-6.181,P=0.000)。结论C ISH与AH相比,创伤轻,对机体免疫功能影响小,一定程度上保护了机体的免疫功能。
Objective To study effects of classical intrafascial supracervical hysterectomy （CISH） on immune functions. Methods A total of 60 women with benign gynecopathy requiring a hysterectomy were randomly divided into two groups with 30 patients in each group, receiving either CISH or abdominal hysterectomy （AH）. The white blood cell （WBC） count and neutrophil granulocyte percentage before and 1 day after the surgery, and peripheral T - lymphocyte subgroup （ CD3, CD4, and CDs ） , interleukin- 2 （IL- 2） , and intedeukin -10 （IL- 10） 1 day before and 1 and 4 days after the surgery were measured, respectively. Results Postoperative levels of CD3 and CD4 in both groups decreased significantly at 1 day after operation （CISH Group： qCD3 = 6. 033 ,qCD4 = 4. 763 ; AH Group ： qCD3 = 11. 043, qCD4 = 9. 202 ; P 〈 0.05 ） , and were significantly lower in AH Group than in CISH Group （tCD3 =4. 509 ,PCD3 =0. 000; tCD4 = 2. 494, PCD4 = 0. 016）. As compared with preoperative levels, the CD3 and CD4 at 4 days after operation were not statistical significance in the CISH Group （QCD3 = 1. 046, qCD4 =0. 238, P 〉0.05）, and were significantly higher （qCD3 = 6.531, qCD4 = 5. 269, P 〈 0.05 ） , with significant difference between the two groups （ t CD3 = 4. 251 , PCD3 = 0. 000 ; tCD4 = 3. 389, PCD4 =0. 001 ）. The levels of CD8 decreased slightly after operation without statistical difference in both groups （CISH Group： F=0.98, P=0.379; AH Group： F=0.29,P=0.752）. The levels oflL-10 did not increase significantly 1 and4 days after operation in the CISH Group （F = 2. 24, P = 0. 113）, but were elevated remarkably in the AH Group （q1-2 = 20. 182, q1-3 = 15. 933, P 〈0.05） , with significant difference between the two groups （ 1 day after operation： t = - 11. 632, P =0. 000; 4 days after operation： t = - 7. 745, P = 0. 000）. The peripheral concentrations of IL - 2 decreased significantly at 1 day after operation （q =5. 465, P 〈0.05） , but gradually increased to the
出处
《中国微创外科杂志》
CSCD
2005年第10期813-816,共4页
Chinese Journal of Minimally Invasive Surgery
