摘要
目的通过分析单核细胞HLA-DR表达和体外刺激下细胞因子的分泌来比较开腹手术和腹腔镜手术术后免疫抑制情况。方法将2012年1月-2013年12月内收治的50例行肝切除患者,随机分为LH组和OH组,比较两组手术前后部分肝功能指标、平均切口长度、手术时间、麻醉时间及术中出血量的变化。流式细胞仪检测和比较两组患者单核细胞HLA-DR的表达特征,ELISA检测和比较脂多糖刺激后细胞中TNF-α、INF-γ、IL-6及IL-8等炎症因子的含量。结果两组术后ALT和AST迅速升高,与术前相比差异显著,而且OH组明显高于LH组。切口长度和出血量LH组明显小于OH组(P<0.1);LH组手术时间、麻醉时间长于OH组,但差异无显著性(P>0.05)。LH组中未出现术后免疫麻痹现象。术后第1天LH组II类主要组织相容性复合物升高,而开腹手术组II类主要组织相容性复合物下降。OH组患者术后TNF-α、IL-6和IFN-γ的分泌低于LH组。结论在行开腹或腹腔镜肝切除术患者中均未发现免疫麻痹现象,但是腹腔镜组患者在肝切除后免疫功能恢复情况较好。
【Objective】To compare the effects of open and laparoscopic surgery on postoperative immunosuppression by analyzing monocytic HLA-DR expression and ex vivo stimulated cytokine secretion. 【Methods】Fifty patients scheduled to undergo hepatectomy were divided into LH group and OH group randomly from Jan 2012 to Dec2013. Data of pre-and post-operative liver function, length of incision, surgical and anesthetic duration and intraoperative blood loss in the two groups were compared. Flow cytometric characteristics of HLA-DR expression of monocytes and lipopolysaccharide-stimulated cellular secretion of tumor necrosis factor, interferon,interleukin 6,and interleukin 8 were measured and analyzed in ex vivo whole blood samples. 【Results】Postoperative mean value of ALT and AST in LH group and OH group was elevated quickly, and the postoperative mean value of these markers was significantly different compared to that of the preoperative value, and the mean value in OH Was higher than that in LH. The mean of data LH group was significantly less than that of Oh group in length of incision and intraoperative blood loss（ P〈0.1）. There were no significant difference of surgical and anesthetic duration（ P〈0.05）. Laparoscopic liver resection showed no postoperative immunoparalysis. Major histocompatibility complex class II expression in this group was elevated, whereas the open surgery group showed decreased major histocompatibility complex class II expression on postoperative day 1. Postoperative secretion of tumor necrosis factor, interleukin 6, and interferon was lower in the open surgery group. 【Conclusion】Major immunoparalysis depression was not observedin either group. Laparoscopic surgery shows a tendency to improve immunologic recovery after liver resection.
出处
《中国内镜杂志》
北大核心
2015年第7期684-688,共5页
China Journal of Endoscopy
关键词
肝切除
腹腔镜
HLA-DR表达
免疫
刺激细胞分泌
术后免疫抑制
liver resection
laparoscopy
HLA-DR expression
immunology
stimulated cellular secretion
postop-erative immunosuppression
