无张力疝修补术患者围手术期血细胞因子的变化  

Cytokine changes after tension-free hernioplasty or conventional hernioplasty

作　　者：马晓望[1] 俞毅君[1] 徐鑫[1] 

机构地区：[1]杭州师范学院附属医院普外科,杭州310015

出　　处：《浙江医学》2007年第1期20-22,共3页Zhejiang Medical Journal

摘　　要：目的通过观察无张力疝修补术患者围手术期血细胞因子Th1和Th2的变化,以探讨无张力疝修补术后炎症反应对机体的影响。方法对行传统疝修补术的20例患者和无张力疝修补术的21例患者在术前24h及术后6、24、48、168h采集外周血样,采用放射免疫法测定IL-6、IFN-γ、IL-13、IL-4和IL-10水平。结果术后两组患者的IL-6的水平较术前显著增高,其中无张力疝修补术组立即明显升高,术后6～24h达到高峰,术后7d逐渐恢复到术前水平,这种变化较传统外科手术组更为显著。两组的IL-10水平与术前相比明显增高,虽然传统的外科手术组高于无张力疝修补术组,但这种差别并不明显。无张力疝修补术组患者的INF-γ水平与术前相比显著增加,而传统的外科手术组无明显变化。两组患者的血清IL-13和IL-4水平与术前相比无明显变化。结论无张力疝修补术患者存在Th1介导的细胞免疫反应。这些现象可能是聚丙烯补片所造成的。可能正是这种炎症反应对疝修补起积极的作用,使补片的周围形成疤痕组织,从而降低术后复发率。Objective To investigate the inflammatory response after tension-free hernioplasty by measuring Th1-like and TH2-like cytokines. Methods Peripheral venous blood samples were collected in patients with tensionfree hernioplasty and conventional hernioplasty 24 hours prior to surgery and then 6, 24, 48, and 168 hours postoperatively. Serum IL-6, IFN-γ, IL-13,IL-4,and IL-10 levels were determined with radioimmunoassay. ResuIts IL-6 levels were significantly increased in both groups compared with their levels before operation. However, in patients who underwent tension-free hernioplasty, IL-6 increased immediately after the operation, with a peak between 6 and 24h after operation, declining to the preoperative levels 7d afterwards, which were significantly higher than those observed in conventional hernioplasty. Serum IL-10 levels were significantly increased than preoperative levels in both groups. IFN-γ levels were significantly increased compared with preoperative levels in tension-free hernioplasty patients, but not in conventional hernioplasty patients. Serum IL-13 and IL-4 levels showed no significant changes compared with preoperative levels in both groups. ConcInsion Tension-free hernioplasty is associated with Th1 mediated immunity, likely induced by the presence of the polypropylene prostheses.

关 键 词：疝修补术 细胞因子 补片 

分 类 号：R656.2[医药卫生—外科学]