腹腔镜与开腹筋膜内子宫切除术对患者免疫功能影响的大样本分析

摘要

目的 研究腹腔镜和开腹行筋膜内子宫切除术对患者机体免疫功能的影响.方法 选择2002年9月～ 2010年12月在余姚市第一人民医院行筋膜内子宫切除术以腹腔镜术者710例和开腹术者653例.测定术前24h、术后24、72 h血白细胞计数(WBC)、中性粒细胞比率(NGR)、C反应蛋白(CRP)、血清白细胞介素(IL)-2、白细胞介素(IL)-4和白细胞介素(IL)-6,并比较两种术式的手术时间、术中出血量、术中排气时间、术后镇痛用药率、术后病率.结果 开腹组术后24、72 h WBC计数、NGR、CRP、IL-4、IL-6均高于术前(P＜0.05),腹腔镜组术后WBC、IL-4升高不明显(P＞0.05),NGR、CRP在术后24 h有增高,幅度低于开腹组(P＜0.05),术后72 h恢复至术前水平,IL-6在术后24、72 h均升高,幅度低于开腹组(P ＜0.05)；IL-2在开腹组术后24、72h均下降,腹腔镜组在术后24h有下降,幅度低于开腹组(P＜0.05),术后72 h恢复至术前水平.与开腹组相比,腹腔镜组术后排气早,镇痛用药少,术后病率低.结论 腹腔镜手术创伤较开腹手术小,对机体免疫功能影响小,更适合患者.%[Objective] To study the effect of laparoscopy classical intrafascial supracervical hysterectomy (CISH) and abdominal hysterectomy (AH) on immune function. [Methods] Patients scheduled for hysterectomy Sep.2002 to Dec.2010 in First Hospital of YuYao were given either CISH with 710 cases or AH with 653 cases. The white blood cell (WBC), Neutrophil granulocyte rate(NGR), C-reactionprotein(CRP), interleukin-2 (IL-2), interleukin-4 (IL-4) and interleukin-6 (IL-6) at 1 day before and 1 and 3 days after operation were measured. Operation time, bleed amount in operation, postoperative exhausting time, postoperative analgesia and postoperative morbidity were compared between two groups. [Results] ?In AH group the white cell count, NGR, CRP, IL-4 and IL-6 were increased significantly at 1 and 3 days after operation (P <0.05). ?In CISH group WBC, IL-4 were not increased significantly after operation (P >0.05). NGR, CRP were increased at 1 day after operation , but the level lower than in AH group (P <0.05), and the level was returned to preoperation at 3 day after operation. The level of IL-6 was increased at 1 and 3 days after operation, but it was lower than in AH group (P <0.05). ?The level of IL-2 was decreased at 1 and 3 days after operation in AH group. But in CISH group it was decreased at 1 day after operationand it was lower than in AH group (P <0.05), and it was returned to preopration at 3 day after operation. @ Compared with AH group, CISH group had shorter postoperative exhausting time, lower postoperative analgesia and lower febrile morbidity (P <0.05). [ Conclusion ] CISH cased less tissue injury ,so it does not significantly affect immune function ,compared with AH.