腹腔镜胆囊切除术与开腹胆囊切除术治疗胆囊结石患者外周血淋巴细胞和细胞因子水平的变化

2016-09-07鲁德斌刘西平胡林忠

实用肝脏病杂志 2016年3期

鲁德斌，刘西平，胡林忠

·胆石症·

腹腔镜胆囊切除术与开腹胆囊切除术治疗胆囊结石患者外周血淋巴细胞和细胞因子水平的变化

鲁德斌，刘西平，胡林忠

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）m l，显著低于OC组【（103.5±15.5）m l，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±14.1 ng/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。

胆囊结石；开腹胆囊切除术；腹腔镜胆囊切除术；淋巴细胞亚群；细胞因子

【Abstract】Objective To compare the changes of peripheral blood lymphocyte subsets and serum cytokines in patients with gallbladder stones receiving laparoscopic cholecystectomy（LC）versus open cholecystectomy（OC）. Methods A retrospective analysis was made in 57 patients 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）m l vs.（103.5±15.5）m l，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<0.05and（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 postoperation 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[（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[（32.4±7.4）%,（29.5±6.9）%and（25.3±7.0）%，P<0.05]；serum levels of IL-6 at day one，three and seven postoperation in OC group were（95.9±10.1）pg/L，（58.4±8.1）pg/L and（33.8±4.6）pg/L，significantly 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-αin OC group were（49.0±10.2）ng/L，（65.8±14.1）ng/L and（41.5±8.8）ng/L，significantly higher than those in the LC group [（34.0±9.9）ng/L，（40.7±10.6）ng/L and（19.8±7.7）ng/L，P<0.05]；serum levels of CRP in OC group were（32.4±3.6）mg/L，（25.8±2.7）mg/L and（15.4±4.2）mg/L，significantly higher than those in the LC group[（20.5±3.0）mg/L，（12.4±2.0）mg/L and（6.6±1.1）mg/L，P<0.05]；the incidence of adverse reactions in the LC group was 17.5%，significantly lower than that in the OC group（31.6%，P<0.05）.Conclusions The laparoscopic cholecystectomy has smaller operation trauma，lighter stress response and immune function suppression，quicker postoperative recovery and fewer adverse reactions.

【Key words】Gallbladder stones；Open cholecystectomy；Laparoscopic cholecystectomy；Lymphocyte subsets；Cytokines

随着人们营养状态的改善和生活水平的提高，我国胆囊结石发病率呈逐年上升趋势[1]。胆囊切除术一直被国际上公认为是治疗胆囊结石的“金标准”[2]。以往临床上常采用开腹胆囊切除术（Open cholecystectomy，OC）治疗，但创伤大，术后恢复慢[3]。有研究发现手术创伤可以抑制免疫功能，引发应激反应，从而容易引发并发症的发生，影响患者术后的转归[4]。腹腔镜胆囊切除术（Laparoscopic cholecys tectomy，LC）作为一种微创技术，具有创伤小，术后恢复快的特点，经过20多年临床不断的应用和经验积累，已经被推荐应用于各种慢性有症状的胆囊炎、胆囊息肉和胆囊结石等疾病的治疗[5，6]。本文分析了采用LC和OC治疗胆囊结石患者的疗效，并分析了不同手术对患者术后外周血淋巴细胞和细胞因子水平的影响，现将结果报告如下。