摘要
目的比较腹腔镜胆囊切除术(LC)与开腹胆囊切除术(OC)治疗胆囊结石患者的疗效及术后外周血淋巴细胞和细胞因子水平的动态变化。方法回顾性分析57例行LC和57例行OC治疗的胆囊结石患者的临床资料,使用FACSCalibur流式细胞仪检测外周血CD3+、CD4+、CD8+T细胞亚群百分比;采用ELISA法检测血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和C-反应蛋白(CRP)水平。结果 LC组术中出血量为(66.4±17.6)ml,显著低于OC组[(103.5±15.5)ml,P<0.05],术后通气时间为(1.5±0.5)d,显著低于OC组[(3.0±1.0)d,P<0.05],住院时间为(5.0±1.0)d,显著低于[(8.0±2.0)d,P<0.05)];术后OC组第1天、第3天和第7天外周血CD3+淋巴细胞分别为(29.4±5.6)%、(38.9±6.3)%和(52.1±7.7)%,均显著低于LC组[分别为(36.0±6.1)%、(46.5±7.5)%和(63.8±8.8)%,P<0.05],CD4+淋巴细胞分别为(21.9±4.2)%、(28.8±4.4)%和(36.0±8.3)%,均显著低于LC组[(27.7±6.4)%、(34.9±8.0)%和(44.9±8.0)%,P<0.05],CD8+淋巴细胞分别为(37.1±6.8)%、(32.3±7.0)%和(29.5±7.4)%,均显著高于LC组[(32.4±7.4)%、(29.5±6.9)%和(25.3±7.0)%,P<0.05];术后OC组第1天、第3天和第7天血清IL-6水平分别为(95.9±10.1)pg/L、(58.4±8.1)pg/L和(33.8±4.6)pg/L,显著高于LC组[(72.0±9.4)pg/L、(35.9±5.2)pg/L和(19.0±3.4)pg/L,P<0.05],血清TNF-α为(49.0±10.2)ng/L、(65.8±14.1ng/L)和(41.5±8.8)ng/L,均显著高于LC组[(34.0±9.9)ng/L、(40.7±10.6)ng/L和(19.8±7.7)ng/L,P<0.05],血清CRP为(32.4±3.6)mg/L、(25.8±2.7)mg/L和(15.4±4.2)mg/L,均显著高于LC组[(20.5±3.0)mg/L、(12.4±2.0)mg/L和(6.6±1.1)mg/L,P<0.05];术后LC组出现不良反应发生率为17.5%,显著低于OC组的31.6%(P<0.05)。结论与传统开腹胆囊切除术相比,腹腔镜胆囊切除术创伤小,应激反应和免疫功能抑制轻,术后恢复快,不良反应少,综合疗效优。
Objective To compare the changes of peripheral blood lymphocyte subsets and serum cytokines in patients with gallbladder stones receiving laparoscopic cholecystectomy （LC） versus open chotecystectomy （OC）. Methods A retrospective analysis was made in 57 patients with gallbladder stones receiving LC and 57 receiving OC. The peripheral blood T lymphocyte subsets were detected by FACSCalibur flow cytometry,and serum interleukin-6 （IL-6）,tumor necrosis factor （TNF）-alpha and C-reactive protein （CRP） levels were detected by ELISA. Results The amount of bleeding in LC group was significantly lower than in OC group [（66.4±17.6） ml vs. （103.5±15.5） ml,P〈0.05];postoperative intestinal peristalsis function restoration and hospitalization times in LC group were significantly shorter than in OC group [（1.5±0.5） d vs.（3.0±1.0） d,P〈0.05 and （5.0±1.0） d vs. （8.0± 2.0） d,respectively,P〈0.05）];the peripheral blood CD3^＋T lymphocyte percentages at day one,three and seven post-operation were （29.4±5.6） %,（38.9±6.3） % and （52.1±7.7） % in OC group,significantly lower than those in the LC group r（36.0±6.1）%,（46.5±7.5） % and （63.8±8.8） %,P〈0.05];the CD4^＋T lymphocyte were （21.9±4.2） %,（28.8±4.4） % and （36.0±8.3） % in the OC group,significantly lower than those in the LC group [（27.7± 6.4）%,（34.9±8.0） % and （44.9±8.0） %,P〈0.05];the peripheral blood CD8^＋ T lymphocyte in the OC groups were （37.1±6.8） %,（32.3±7.0） % and （29.5±7.4） %, significantly lower than those in the LC groups E（32.4±7.4）%, （29.5±6.9）% and （25.3±7.0） %,P〈0.O5];serum levels of IL-6 at day one,three and seven post-operation in OC group were （95.9±10.1） pg/L, （58.4±8.1） pg/L and（33.8±4.6）pg/L,signifieantly higher than those in the LC group [（72.0±9.4）pg/L,（35.9±5.2）pg/L and （19.0±3.4）pg/L,P〈0.05];serum levels of TNF-α in OC group were （49.0±10.2）ng/L,（65.8±14.1）ng/L and �
出处
《实用肝脏病杂志》
CAS
2016年第3期335-338,共4页
Journal of Practical Hepatology
