肝硬化患者腹腔镜与开腹胆囊切除术后免疫炎症功能变化的对比研究

摘要

Objective To analyze the effect of laparoscopic or laparotomy cholecystectomy on the immune inflammation function in patients with cirrhosis. Methods Cirrhosis combined cholecystectomy patients were selected and divided into two groups: laparoscopic group and laparotomy group. Recorded the highest temperature after operation, the value of total white blood cells, PCT, CD4+and CD8+T lymphocyte, and also the ratio of CD4+/CD8+before 1 day and 1 day, 3 days and 5 days after operation. Results No difference were be found between total white blood cells, PCT, CD4+and CD8+T lym-phocyte, and also the ratio of CD4+/CD8+before 1 day of operation (t=0.15,1.60,1.06,1.47,0.63,P>0.05). After 1 day, there were differences in PCT, CD4+and CD8+T lymphocyte number between the two groups (t=4.34,4.99,4.08,P<0.05). Postoperative 3 and 5 days, in laparoscopic group, the total white blood cells and PCT lower, and the CD4+, CD8+T lym-phocyte, ratio of CD4 +/CD8 + were highter than those of the laparotomy group with statistic significance (t =3.63,2.89,4.53,3.02,6.13; 3.60,3.77,1.99,6.08,P<0.05), except the value of CD8+ T lymphocyte in postoperative 5 days (t=1.50,P>0.05). Conclusion The laparoscopic cholecystectomy has small impact on the immune inflammation function than laparotomy cholecystectomy, and could reduce the risk of postoperative infection in patients with cirrhosis.%目的：探讨肝硬化患者腹腔镜与开腹胆囊切除术后对免疫功能的影响。方法回顾性分析接受腹腔镜或开腹胆囊切除术的肝硬化患者，根据手术方式分为腹腔镜组和开腹手术组，分析两组间术后记录的最高体温以及术前1 d、术后1 d、3 d和5 d白细胞总数、PCT以及CD4+、CD8+T淋巴细胞和CD4+/CD8+比值间有无差别。结果两组术前白细胞总数、PCT、CD4+T淋巴细胞、CD8+T淋巴细胞以及CD4+/CD8+比值等因素比较，差异均无统计学意义（t分别=0.15、1.60、1.06、1.47、0.63，P均＞0.05）。术后第1天，两组患者间白细胞总数和CD4+/CD8+比值差异均无统计学意义（t分别=0.87、1.51，P均＞0.05）；两组患者间PCT、CD4+T和CD8+T淋巴细胞绝对值差异有统计学意义（t分别=4.34、4.99、4.08，P均＜0.05）。术后第3天，腹腔镜组白细胞总数以及PCT均明显低于开腹组，CD4+T和CD8+T淋巴细胞绝对值以及CD4+/CD8+比值高于开腹组，差异有统计学意义（t分别=3.63、2.89、4.53、3.02、6.13，P均＜0.05）。术后第5天，腹腔镜组白细胞总数、PCT均低于开腹组，CD4+T淋巴细胞以及CD4+/CD8+高于开腹组，差异均有统计学意义（t分别=3.60、3.77、1.99、6.08，P均＜0.05），两组间CD8+T淋巴细胞绝对值差异无统计学意义（t=1.50，P＞0.05）。结论腹腔镜胆囊切除术对肝硬化患者术后免疫炎症功能的影响较开腹手术小，可以降低肝硬化患者术后感染的风险。