目的:比较腹腔镜手术与传统开腹手术对机体免疫功能的影响,从而为腹腔镜手术的微创性提供更多依据。方法:收集2008年1月~2009年8月在舟山市妇幼保健院就诊的因良性妇科疾病行腹腔镜手术者473例,行开腹手术者614例,对比腹腔镜组和开腹组手术前24 h,术后24 h、72 h患者外周血白细胞、中性粒细胞、细胞因子(IL-6、TNF-α)的变化情况,以及两组手术时间、术中出血量、术中术后并发症发生率、术后恢复情况及总住院费用等指标。结果:两组患者均术程顺利,腹腔镜组术中出血量、术后排气时间、术后住院时间均少于开腹组,但手术时间、治疗费用较开腹组多(P<0.0005)。开腹组术后24 h白细胞计数平均值明显高于术前;到术后72h有所下降,但仍高于术前水平。腹腔镜组术后24 h白细胞水平也高于术前,但其升高程度却低于开腹组,至术后72 h,白细胞数已接近术前水平。两组术后24 h中性粒细胞均明显升高,且两组间无统计学差异,至术后72 h两组中性粒细胞水平均已恢复到术前状态。血清IL-6水平在腹腔镜组和开腹组术前24 h均明显低于术后24 h,但腹腔镜组术后24 h血清IL-6浓度的峰值低于开腹组;两组术后72 h分别下降至术前水平。TNF-α在腹腔镜组和开腹手术组术前24 h均值明显高于术前水平,两组升高程度接近,术后72 h两组TNF-α水平分别下降至术前水平。结论:腹腔镜手术患者术中出血少,术后胃肠功能恢复快,住院天数短,但手术时间较长,住院总费用较高;两种手术途径对机体的吞噬细胞功能均有抑制作用,但其抑制程度在腹腔镜组低于开腹组。 Objective: To compare the impact of laparoscopic surgery and traditional laparotomy on immune function, so as to provide more basis for minimally invasive laparoscopic surgery. Methods: 473 cases of benign gynecological diseases who underwent laparoscopic surgery in Zhoushan MCH from January 2008 to August 2009 were collected, and 614 cases underwent laparotomy. The changes of laparoscopic group and open group before operation The changes of leukocyte, neutrophil and cytokines (IL-6, TNF-α) in 24 h, 24 h and 72 h after operation were compared between the two groups. The operation time, intraoperative blood loss, intraoperative and postoperative Complications, postoperative recovery and total hospital costs and other indicators. Results: The patients in both groups had a smooth operation. The bleeding volume, postoperative exhaust time and postoperative hospital stay in the laparoscopic group were less than those in the laparotomy group. However, the operation time and cost were more than those in the laparotomy group (P <0.0005 ). The average number of leukocytes 24 hours after operation was significantly higher in the open group than in the preoperation, but decreased to 72 hours after operation, but still higher than the preoperative level. The levels of leukocytes in the laparoscopic group at 24 h after operation were also higher than those in the laparotomy group. However, at 72 h after operation, the number of white blood cells was close to preoperative level. Neutrophils in both groups were significantly increased 24 hours after operation, and there was no significant difference between the two groups. Neutrophil levels recovered to preoperative level at 72 hours after operation in both groups. Serum IL-6 levels in laparoscopic group and laparotomy 24 h before surgery were significantly lower than 24 h after operation, but the laparoscopic group 24 h after the serum IL-6 concentration peak was lower than the open group; two groups of surgery After 72 h were decreased to preoperative levels. The average value of TNF-α in laparoscopic group and laparotomy group before operation was significantly higher than preoperative level at 24 h, and the level of TNF-α was similar in both groups. The level of TNF-α decreased to preoperative level at 72 h after operation. Conclusions: Laparoscopic surgery has less intraoperative bleeding, faster recovery of postoperative gastrointestinal function, shorter days of hospitalization, longer operation time and higher total cost of hospitalization. Both of the two surgical approaches have an inhibitory effect on phagocyte function of the body, However, its inhibition was lower in laparoscopic group than in open group.