摘要
目的探讨腹腔镜胆总管切开取石术（LCHTD）对患者肝功能、血黏度及免疫功能的影响。方法选择2012年7月～2014年1月在高州市人民医院行LCHTD患者50例为腹腔镜组。另选择同期行传统开腹取石术50例为对照组,比较两组患者术前及术后第1、3、7天谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（TBIL）、白蛋白（ALB）及全血黏度、全血还原黏度及血浆黏度、血细胞比容（HCT）,免疫球蛋白IgA、IgG、IgM及CD3＋、CD4＋、CD8＋及CD4＋/CD8＋的变化。结果①术后1 d,两组患者ALT、AST、TBIL均较术前显著升高,而ALB较术前明显降低,差异均有统计学意义（P〈0.05）,但腹腔镜组术后1 d上述指标与对照组比较差异无统计学意义（P＆gt;0.05）。术后3 d腹腔镜组患者ALT、AST水平明显低于对照组,差异有统计学意义（P〈0.05）。②两组患者血浆黏度术后1 d均较术前明显升高,而术后3 d较术后1 d明显降低,但腹腔镜组患者术后1 d的血浆黏度明显低于对照组,差异均有统计学意义（P〈0.05）。腹腔镜组术后3 d全血黏度高切、低切分别明显低于对照组,差异均有统计学意义（P〈0.05）。③术后1 d,两组患者IgA、IgG、IgM水平均较术前明显降低（P〈0.05）;术后1 d腹腔镜组患者IgA、IgG、IgM分别明显高于对照组,差异有统计学意义（P〈0.05）。④术后1 d,两组患者CD4＋及CD4＋/CD8＋均明显低于术前（P〈0.05）,且腹腔镜组患者术后1 d的CD4＋/CD8＋水平明显低于对照组（P〈0.05）。术后3 d,腹腔镜组患者CD3＋、CD4＋与对照组比较,差异有统计学意义（P〈0.05）。结论 LCHTD较传统开腹取石术对患者肝功能损害小,能明显降低血黏度,且对患者的免疫功能影响小,能更好地减少机体创伤,保护机体免疫功能。
Objective To investigate the effects of laparoscopic common bile duct stone surgery for liver function, blood viscosity and immune function. Methods From July 2012 to January 2014 in People＇s Hospital of Gaozhou City, 50 patients of choledocholithotomy laparoscopic surgery were selected as the laparoscopic group, 50 cases of concomitant traditional open stone surgery were chose as the control group. Before and 1, 3, 7 days after the surgery, the ALT, TBIL,ALB and whole blood viscosity, whole blood viscosity and plasma viscosity reduction, HCT, immunoglobulin IgA, IgG,IgM, and CD3＋, CD4＋, CD8＋, CD4＋/CD8＋changes were compared between two groups. Results ① 1 day after the surgery, the ALT, AST, TBIL of two groups were all higher than those before the surgery, and the ALB was lower than that before the surgery, the differences were statistically significant（P〈0.05）. The differences of the indexes 1 day after the surgery between the two groups was not statistically significant（P〈0.05）. The ALT, AST in laparoscopic group3 days after the surgery were all lower than those in control group, the differences were statistically significant（P〈0.05）. ②The plasma viscosity of the two groups 1 day after the surgery was higher than those before the surgery, and the plasma viscosity of the two groups 3 days after the surgery was lower than that 1 day after the surgery, but the plasma viscosity of laparoscopic group 1 day after the surgery was lower than that of the control group, the differences were statistically significant（P〈0.05）. The high-cut and low-cut of whole blood viscosity 3 days after the surgery in the two groups were all lower than those in control group, the differences were statistically significant（P〈0.05）. ③The IgA,IgG, IgM levels of two groups 1 day after the surgery were all lower than those before the surgery, the differences were statistically significant（P〈0.05）. The IgA, IgG, IgM levels in laparoscopic group 1 day after the surgery were all lower than those in control group, the differences were statistically significant（P〈0.05）. ④CD4＋and CD4＋/CD8＋of two groups 1 day after the surgery were all lower than those before the surgery（P〈0.05）, and the CD4＋/CD8＋levels of laparoscopic group 1 day after the surgery was lower than that of the control group（P〈0.05）. The differences of CD3＋,CD4＋between the two groups 3 days after the surgery were statistically significant（P〈0.05）. Conclusion Laparoscopic surgery choledocholithotomy on liver function has small damage than traditional open stone surgery, and it can significantly reduce blood viscosity, and has small impact on the immune function, can reduce body trauma, protective immune function.
出处
《中国医药导报》
CAS
2014年第20期44-47,58,共5页
China Medical Herald
基金
广东省茂名市医学科技计划立项项目(编号2012155)
关键词
腹腔镜胆总管切开取石术
肝功能
血黏度
免疫球蛋白
Choledocholithotomy laparoscopic surgery
Liver function
Blood viscosity
Immunoglobulin
