目的:比较腹腔镜与开腹行急性胆囊切除术对体液免疫功能与机体能量代谢的影响。方法:将60例急性结石性胆囊炎患者随机地均分为观察组与对照组,每组各30例,观察组行腹腔镜胆囊切除术,对照组行开腹胆囊切除术。比较两组手术相关指标、手术前后免疫功能变化及能量代谢与营养指标的变化。结果:与对照组比较,观察组手术时间、术中出血量明显减少,术后排气时间及下床活动时间明显缩短(均P<0.05);两组术后IgG、IgM、IgA、C3、C4和IL-4水平以及静态能量消耗(REE)与呼吸商(RQ)值均较术前明显降低,但观察以上指标的降低程度小于对照组以及降低的持续时间短于对照组(均P<0.05);两组术后7 d白蛋白(ALB)、转铁蛋白(TRF)、三头肌皮褶厚度(TSF)、上臂肌围(AMC)均较术前明显降低,但观察组的降低程度均低于对照组(均P<0.05)。结论:腹腔镜急性胆囊切除术疗效优于开腹手术,且具有对体液免疫功能及影响小及能量代谢消耗少等优点。 Objective: To compare the effects of laparoscopic and open laparotomy on humoral immune function and body energy metabolism. Methods: Sixty patients with acute calculous cholecystitis were randomly divided into observation group and control group, with 30 cases in each group. The observation group underwent laparoscopic cholecystectomy and the control group underwent open cholecystectomy. The operation-related indexes, the changes of immune function before and after surgery, and the changes of energy metabolism and nutrition indexes were compared between the two groups. Results: Compared with the control group, the operation time and blood loss in the observation group were significantly reduced, the time of extubation and the time of getting out of bed were significantly shorter (all P <0.05). The postoperative IgG, IgM, IgA, C3, C4 and IL-4, as well as the static energy expenditure (REE) and respiratory quotient (RQ) were significantly lower than those before surgery, but the reduction of the above indexes was less than that of the control group and the duration of reduction was shorter than that of the control group (all P < 0.05). Serum albumin (ALB), transferrin (TRF), triceps skin fold thickness (TSF) and AMC in the two groups at 7th day after operation were significantly lower than those before operation, but decreased in the observation group The degree was lower than the control group (all P <0.05). Conclusions: Laparoscopic acute cholecystectomy is more effective than laparotomy and has the advantages of less humoral immune function, less energy consumption and less energy consumption.