海南医科大学学报

目的:观察胆结石胆囊切除术式选择对患者免疫及应激反应的影响。方法:对2013年2月~2015年5月于四川省德阳市第二人民医院普外科行胆囊切除术治疗的胆结石合并胆囊炎患者150例进行观察,其中行腹腔镜胆囊切除术治疗的患者75例设为LC组,行小切口胆囊切除术治疗的75例患者设为MC组,比较2组患者手术后机体免疫功能、手术应激反应相关指标的变化。结果:2组术后1d患者免疫功能有所下降,MC组CD³⁺、CD⁴⁺水平降低更为明显(P<0.05);2组术后7d患者免疫功能有所提高,IgG、IgA、IgM、CD8+水平已基本恢复至术前状态,CD³⁺、CD⁴⁺仍低于术前(P<0.01);2组术后1d患者应激反应指标较术前升高,MC组升高更为明显(P<0.01);术后7d各项应激指标有所下降,但皮质醇、BG、CRP 3项指标仍高于术前(P<0.01),MC组CRP水平明显高于LC组(P<0.05);2组术后并发症发生率比较差异无统计学意义(P>0.05)。结论:LC与MC均存在着优势及不足,2种术式对患者免疫功能影响较小,但MC对患者术后应激反应影响较大,治疗中应根据患者实际身体情况进行术式选择。

Objective:To observe the effect of the selection of surgical methods of cholecystectomy on the immunity and stress reaction in patients with gallstones.Methods:A total of 150 patients with gallstones merged with cholecystitis who were admitted in our hospital from February,2013 to May,2015 for cholecystectomy were included in the study and divided into LC group and MC group with 75 cases in each group.The patients in LC group were performed with laparoscopic cholecystectomy,while the patients in MC group were performed with mini-incision cholecystectomy.The related indicators of immunological function and stress reaction in the two groups were compared.Results:The immunological functions 1dafter operation in the two groups were reduced,and the reduced degree of CD³⁺and CD⁴⁺in MC group was more significant(P<0.05).The immunological functions 7dafter operation in the two groups were elevated,IgG,IgA,IgM,and CD8+levels were basically recovered to the preoperative state,while CD³⁺and CD⁴⁺levels were still lower than those before operation(P<0.01).The stress reaction indicators 1dafter operation in the two groups were elevated when compared with before operation,and the elevated degree in MC group was significantly superior to that in LC group(P<0.01).The stress reaction indicators 7dafter operation were reduced,but cortisol,BG,and CRP were still higher than those before operation(P<0.01),and CRP level in MC group was significantly higher than that in LC group(P<0.05).The difference of the occurrence rate of postoperative complications between the two groups was not statistically significant(P>0.05).Conclusions:LC and MC have their own advantages and disadvantages.The two surgical methods have small effects on the immunological function,but MC has a great effect on thepostoperative stress reaction;therefore,during the treatment process,the surgical method should be selected according to the patients practical physical conditions.