胆总管结石内镜下取石与开腹取石对机体炎症反应和免疫功能的影响  

Impact of endoscopic sphincterotomy and bile duct exploration with open surgery on inflammatory response and immune function

作　　者：方兰[1] 黎朝良[2] 王斌[1] 李彩丽[1] 孙泽群[1] 

机构地区：[1]湖北医药学院附属人民医院消化内科,湖北省十堰市442000 [2]湖北医药学院附属人民医院普通外科,湖北省十堰市442000

出　　处：《中华消化内镜杂志》2012年第10期577-580,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜下乳头括约肌切开取石术与开腹胆道探查术对机体炎症反应和免疫功能的影响。方法将2010年6月至2012年2月共51例胆总管结石患者按其意愿分为内镜治疗组（内镜组，24例）和开腹手术组（开腹组，27例），比较两组患者围手术期外周血降钙素原、c反应蛋白、免疫球蛋白（Iga、IgG、IgM）及T淋巴细胞亚群（CIM、CD8、CD4／CD8比值）的变化。结果术后内镜组和开腹组患者的降钙素原[（8．05±2．98）μg/L和（5．42±1．57）μg/L]、C反应蛋白[（62．0±15．49）mg／L和（45．73±12．65）mg／L]均较术前[（0．56±0．14）μg/L和（0．60±O．11）μg/L，（9．39±3．27）mg／L和（9．22±3．12）mg／L]明显升高（P均〈0．01），且两组的降钙素原、c反应蛋白水平差异有统计学意义（P均〈0．05），但术后3d、5d两组的差异即无统计学意义（P均〉0．05）。术后两组患者的免疫球蛋白水平均较术前显著降低（P均〈0．05），但内镜组IgA[（1．08±0．36）g／L]、IgM[（0．92±0．23）g／L]水平明显高于开腹组[（0．60±0．23）g／L，（0．60±0．11）g／L]（P均〈0．05），术后两组的IgG水平无显著差异（P均〉0．05）。内镜组术后ldCD4、CD8水平及CD4／CD8比值较术前仅轻度下降（P均〉0．05），且术后5d均恢复至术前水平，而开腹组术后CD4、CD8水平及CIM／CD8比值较术前显著下降（P均〈0．05），术后两组问的差异明显（P〈0．05）。结论内镜下乳头括约肌切开取石术与开腹胆道探查术均可诱发患者炎症反应，抑制机体的免疫功能；但内镜下乳头括约肌切开取石术对机体的免疫功能影响更小，且可能主要影响体液免疫，而短时间内诱发的急性炎症反应更为强烈。Objective To evaluate the impact of endoscopic sphincterotomy （EST） and bile duct exploration with open surgery on immune function and inflammatory response. Methods Fifty-one patients with choledocholithiasis were divided into endoscopy group （ EG, n = 24） and laparotomy group （ LG, n = 27 ） according to the patients＇ will from June 2010 to February 2012. Procalcitonin（ PCT）, C-reactive protein （ CRP）, immunoglobulins （IgA,IgG,lgM） and T lymphocyte （ CD4 ,CD8 ） of peripheral blood were exam- ined preoperatively and on the 1st, 3rd and 5th day postoperatively. Results Compared with preoperative levels, postoperative levels of serum PCT and CRP were higher in both groups （P 〈 0. 01 ） , but on the 3rd day after the operation, the changes of PCT and CRP levels in the two groups were not significantly different （ P 〉 0. 05 ）. Postoperative levels of serum immunoglobulins of two groups were lower than preoperative levels （P 〈0. 01 ）, but the IgA and IgM levels in EG were significantly higher than those in the LG （P 〈0. 05）, and IgG levels in the two groups were not significantly different after surgery （ P 〉 0.05 ）. Compared with preoperative levels, postoperative levels of CD4, CD8 and CD4/CD8 ratio in EG were only slightly decreased （P 〉 0. 05 ） , and returned to the preoperative levels on the 5th day postoperatively, but postoperative levelsof these variables in LG were decreased significantly （ P 〈 0. 05 ）. Postoperative levels of CD4, CD8 and CIM/CD8 ration of the two groups were significantly different （P 〈 0. 05 ）. Conclusion Both EST and bile duct exploration with open surgery can inhibit immune function and induce inflammation, but the procedure of EST, which may mainly affect humoral immune function, has impact on immune function less intensely.

关 键 词：胆总管结石 括约肌切开术 内窥镜 剖腹术 急相反应 免疫 

分 类 号：R657.4[医药卫生—外科学]