腹腔镜手术治疗盆腔炎性包块对T细胞免疫功能及术后恢复的影响  

Effect of laparoscopic surgery on cellular immune function of T lymphocyte and recovery after operation in patients with pelvic inflammation mass

作　　者：胡友斌[1,2,3] 何文聪[4,5] 

机构地区：[1]武汉大学基础医学院 [2]青岛大学医学院附属妇女儿童医院 [3]青岛市妇女儿童医院妇科,山东青岛266034 [4]三峡大学第一临床医学院 [5]宜昌市中心人民医院妇产科,湖北宜昌443003

出　　处：《中国实用妇科与产科杂志》2015年第1期82-86,共5页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨腹腔镜与开腹手术治疗盆腔炎性包块对机体细胞免疫功能及术后恢复时间的影响并探讨其间的关系。方法 2008年1月至2011年12月在青岛市妇女儿童医院取56例盆腔炎包块手术患者术前、术后2h、术后24h和术后72h的静脉血标本[腹腔镜手术组32例(腹腔镜组)和开腹手术24例(开腹组)]。流式细胞术(flow cytometry,FCM)测定T细胞亚群CD3+、CD4+和CD8+,对两组各指标的测定值进行比较,同时测定Th1、Th2细胞数量,统计两组之间各亚群以及Th1、Th2和、Th1/Th2比值的差异。酶标法(ELISA)测定血清白介素(IL)-18、IL-10水平,统计两组之间的差异。术后恢复情况:排气时间、体温恢复到正常时间、血象恢复时间、住院时间等。结果腹腔镜组T淋巴细胞亚群手术前后差异均无统计学意义;开腹组术后24 h时CD3+、CD4+、CD8+与术前比较均明显降低,术后72 h时有所回升,但仍低于术前水平;两组比较,开腹组术后CD3+、CD4+、CD8+降低更为明显;两组术后2h均出现Th1/Th2细胞平衡向Th2反应转换,Th1细胞、Th1/Th2比值、IL-18下降(腹腔镜组:t=2.238,P<0.05;t=7.15,P<0.01;t=6.98,P<0.01;开腹组:t=9.45,P<0.01;t=8.56,P<0.01;t=10.17,P<0.01),而Th2细胞、抗炎因子IL-10上升(腹腔镜组:t=7.35,P<0.01;t=8.87,P<0.01;开腹组:t=6.53,P<0.01;t=7.18,P<0.01)。但腹腔镜组术后24h Th1、Th2细胞数、Th1/Th2比值、IL-18、IL-10各项指标即恢复(t=1.82,P>0.05;t=1.38,P>0.05;t=1.72,P>0.05;t=1.78,P>0.05;t=1.89,P>0.05),而开腹组24h各项指标的变化与术后2h类似,并持续至术后48h。结论盆腔炎性疾病手术后细胞免疫功能紊乱可能参与术后的恢复。腹腔镜下盆腔炎性包块切除术组T细胞亚群影响程度小,且Th1/Th2细胞平衡恢复快,对机体的细胞免疫影响小,术后恢复快。Objective To examine cellular immune function and postoperative recovery time after receiving laparoscopy operation tor pelvic inflammation mass and to investigate the relationship between them. Methods Venous blood samples were collected from patients performed operation for pelvic inflammation mass：32 patients with laparoscopy, the left with abdominal operation. Subgroup of T lymphocyte includeing CD^3＋, CD^4＋ and CD^8＋ was examined by flow cytometer and analyzed with own control;meanwhile,determination of Thl and Th2 cells was done. Statistics between the two groups, as well as various subgroup Thl, Th2 and, Thl/Th2 ratio differences were analyzed. ELISA method was used for measuring serum IL-18 and IL-10 level and statistical differences between the two groups were analyzed. Postoperative recovery was analyzed,including exhaust time;time of body temperature returning to normal, recovery time of hemogram and length of stay, etc. Results Laparoscopic group T- lymphocyte subsets before and after surgery had no significant difference.One day Mter laparotomy CD^3＋, CD^4＋ and CD^8＋ ,compared with the preoperative,were significantly lower after 72h＇s recovery, but still lower than the preoperative level;comparison of two groups,in the open group CD^3＋, CD^4＋ and CD^8＋ reduced more obvious.In the two groups after two hours,both Th1/Th2 balance to Th2 cells in response to the conversion, Thl cells, Th1/Th2 ratio, IL-18 decreased（Laparoscopic group： t=2.238, P 〈 0.05; t=7.15,P 〈 0.01;t=6.98,P 〈 0.01; laparotomy group： t=9.45,P 〈 0.01;t=8.56,P 〈 0.01;t=10.17,P 〈 0.01） And Th2 cells, anti-inflammatory cytokines IL- 10 inereased（Laparoscopic group： t=7.35,P 〈 0.01;t=8.87,P 〈 0.01; laparotomy group： t=6.53,P 〈 0.01;t=7.18,P 〈 0.01）. But the laparoscopic group after 24 hours of the indicators that is restored（（t=1.82,P〉0.05; t=1.38, P〉0.05; t=1.72, P〉0.05; t=1.78,P〉0.05; t=1.89, P〉0.05））, and open group of indicators changes and two hours after a si

关 键 词：盆腔炎性包块 腹腔镜 细胞免疫 T细胞亚群 

分 类 号：R711.3[医药卫生—妇产科学]