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目的研究腹腔镜和开腹手术治疗卵巢良性肿瘤对机体免疫功能的影响。方法 2008年7月至12月选择杭州市余杭第一人民医院行腹腔镜和开腹手术治疗的卵巢良性肿瘤患者各30例,测定手术前24h、术后24、72h血白细胞计数(WBC)、中性粒细胞比率(NGR)、血清白细胞介素(IL)-2、IL-6、IL-10、免疫球蛋白IgG、IgA、IgM、补体C3、C4和C反应蛋白(CRP),并比较两种术式的手术时间、术中出血量、术后排气时间、术后镇痛用药率、术后病率。结果开腹组术后24h、72hWBC计数、NGR、CRP、IL-6、IL-10均高于术前(P<0.05),腹腔镜组术后WBC、IL-10增高不明显(P>0.05),NGR、CRP在术后24h有增高,幅度低于开腹组(P<0.05),术后72h恢复至术前水平,IL-6在术后24h、72h均升高,幅度低于开腹组(P<0.05)。开腹组IL-2在术后24h、72h均下降,腹腔镜组在术后24h有下降,幅度低于开腹组(P<0.05),术后72h恢复至术前水平。两组术后IgG均下降,以开腹组更明显(P<0.05)。C3在腹腔镜组无变化(P>0.05),在开腹组术后24h有下降(P<0.05)。两组IgM、IgA、C4手术前后无明显变化(P>0.05)。与开腹组相比,腹腔镜组术后排气早、镇痛用药少、术后病率低。结论腹腔镜手术创伤较开腹手术小,对机体免疫功能影响小。
Objective To study the effect of laparoscopic and open surgery on benign ovarian tumors on immune function. Methods From July 2008 to December 2008, 30 patients with benign ovarian tumors undergoing laparoscopic and open laparoscopic surgery in the First People’s Hospital of Yuhang, Hangzhou were enrolled in this study. The blood leucocyte counts (WBC) at 24h and 72h after operation were measured, Neutrophil ratio (NGR), serum interleukin (IL) -2, IL-6, IL-10, IgG, IgA, IgM, complement C3, C4 and C-reactive protein Two kinds of operation time, intraoperative blood loss, postoperative exhaust time, postoperative analgesic medication rate, postoperative morbidity. Results The counts of WBC, NGR, CRP, IL-6 and IL-10 in the open group at 24h and 72h after operation were significantly higher than those before operation (P <0.05) ), NGR and CRP increased 24h after operation, the amplitude was lower than that of the open group (P <0.05), and returned to the preoperative level 72h after operation. The levels of IL-6 increased at 24h and 72h after operation Abdominal group (P <0.05). IL-2 in laparotomy group decreased at 24h and 72h after operation, and laparoscopic group decreased at 24h after operation (P <0.05), and recovered to preoperative level at 72h after laparotomy. IgG in both groups decreased after operation, especially in the open group (P <0.05). C3 did not change in the laparoscopic group (P> 0.05), but decreased in the laparotomy group (P <0.05) 24h after operation. There was no significant change in IgM, IgA, C4 before and after operation in both groups (P> 0.05). Compared with the open group, laparoscopic group early exhaust, analgesic less medication, postoperative morbidity. Conclusions Laparoscopic surgery is less invasive than laparotomy and has little effect on immune function.