腹腔镜胆囊切除与剖腹胆囊切除术对高血压患者术后疼痛及免疫功能影响的对比研究

摘要

Objective To investigate the ef ect of laparoscopic cholecystectomy (LC)and open cholecystectomy (OC)on the immune function in patients with hypertension.Methods Fifty patients with cholecystolithiasis were randomly divided into two groups:LC and (OC).Peripheral blood samples were obtained during the preoperative day and 1,3 day after operation.Serum cytokines levels (IL-6,IL-10)and C-reactive protein(CRP)were measured.Results Changes of IL-6,IL-10 and CRP before surgery in both groups showed no significant dif erence( >0.05).Serum concentrations of CRP,IL-6 and IL-10 on 1d after surgery in both groups were significantly higher than those before surgery (P<0.05);furthermore,the concentrations of CRP,IL-6 and IL-10 in OC group were significantly higher than those in LC group.Serum concentrations of CRP,IL-6 and IL-10 on 3d after surgery in LC groups were not significantly higher than those before surgery( >0.05);however,the concentrations of CRP,IL-6 and IL-10 in OC group on 3d after surgery were significantly higher than those in LC group and those before surgery in OC group ( <0.05).Conclusion It was indicated that the influence of laparoscopic cholecystectomy on the immune function was less to the patients with hypertension than open cholecystectomy.%目的观察剖腹与腹腔镜胆囊切除术对于高血压患者免疫功能的影响。方法将90例慢性胆囊炎、胆囊结石伴高血压患者随机分为腹腔镜胆囊切除组(LC)和剖腹胆囊切除组(OC)。术前和术后24、72 h采集外周静脉血，评估术后用视觉模拟评分(VAS)，测定C-反应蛋白(CRP)、白介素6(IL-6)及白介素10(IL-10)。结果 LC组患者术后4、24、72 h的VAS评分均低于OC组(<0.05)。两组患者术前CRP、IL-6和IL-10术前无明显差异(>0.05)，而术后24 h均有显著增多(<0.05)，且OC组CRP、IL-6和IL-10水平均高于LC组。术后72 h LC组及OC组CRP、IL-6和IL-10均有所下降，且LC组CRP、IL-6和IL-10均降至术前水平(>0.05)，而OC组72 h时CRP、IL-6和IL-10对比术前和OC术后72 h组均增多(<0.05)。结论与OC相比，LC对高血压患者可能通过小的手术创伤，使创口局部细胞因子释放减少，进而减少痛觉信息从外周传入中枢神经系统。