腹腔镜规则性肝段或肝叶切除治疗复杂性肝内胆管结石患者血浆皮质醇和外周血T淋巴细胞亚群的变化  

Changes of blood cortsisol and peripheral blood T lymphocyte subsets in patients with complicated intrahepatic bile duct stones after laparoscopic regular hepatectomy or lobectomy

作　　者：钱国武 崔广莹 宋展 吕柯 刘驰 孙万日 Qian Guowu;Cui Guangying;Song Zhan(Department of General Surgery,Provincial Central Hospital,Zhengzhou 473009,Henan Province,China)

机构地区：[1]河南省中心医院普外科,郑州市473009 [2]郑州大学第一附属医院肝病科

出　　处：《实用肝脏病杂志》2020年第1期122-125,共4页Journal of Practical Hepatology

基　　金：河南省科技发展计划项目(编号:182102311210)

摘　　要：目的比较腹腔镜下规则性肝段或肝叶切除治疗复杂性肝内胆管结石患者血浆皮质醇(COR)和外周血T淋巴细胞亚群的变化。方法2017年11月~2018年11月我院收治的85例复杂性肝内胆管结石患者,其中52例对照组患者接受开腹肝切除术,33例观察组患者接受腹腔镜下规则性肝段或肝叶切除术。结果观察组手术时间为198.9±15.2 min,显著长于对照组(172.4±18.1 min,P<0.05),术中出血量、术后肛门排气时间和术后住院时间分别为211.1±17.9 mL、18.3±3.1 h和7.8±1.5 d,显著少于或短于对照组【分别为(245.9±23.6 mL、27.5±4.3 h和10.0±2.2 d),P<0.05】;术后3 d,观察组血清COR、C反应蛋白(CRP)、肾上腺素(EP)和白介素-6(IL-6)水平分别为232.5±27.9 nmol/L、15.8±1.6 m g/L、204.3±19.2 ng/mL和72.7±6.9μg/L,均显著低于对照组【分别为(327.0±35.6 nmol/L、31.2±2.8 mg/L、352.8±31.5 ng/mL和111.6±10.3μg/L),P<0.05】;观察组外周血CD3^+、CD4^+和CD8^+细胞百分比分别为58.1±5.2%、37.1±4.1%和28.2±1.7%,与对照组比,差异显著(分别为53.2±4.9%、33.6±4.0%和37.6±3.4%,P<0.05)。结论腹腔镜下规则性肝段或肝叶切除术较开腹肝切除术对患者的创伤更小,能够抑制应激反应,提高机体免疫力,可能更有利于患者术后恢复。Objective The aim of this study was to investigate the changes of blood cortsisol(COR)and peripheral blood T lymphocyte subsets in patients with complicated intrahepatic bile duct stones after laparoscopic regular hepatectomy or lobectomy.Methods 85 patients with complex intrahepatic cholelithiasis were treated in our hospital between November 2017 and November 2018,and 52 of them in the control group underwent open hepatectomy,while 33 patients in the observation group underwent laparoscopic regular hepatectomy or lobectomy.Blood COR and peripheral blood T lymphocyte subsets were assayed.Results The operation time in the observation group was 198.9±15.2 min,significantly longer than[(172.4±18.1 min,P<0.05)in the control,and the intraoperative blood loss,postoperative anal exhaust time and postoperative hospital stay in the observation group were 211.1±17.9 mL,18.3±3.1 h and 7.8±1.5 d,significantly shorter or less than【(245.9±23.6 mL,27.5±4.3 h and 10.0±2.2 d,respectively),P<0.05】in the control;blood COR,C-reactive protein,epinephrine and interleukin-6 levels in the observation group were 232.5±27.9 nmol/L,15.8±1.6 mg/L,204.3±19.2 ng/mL and 72.7±6.9μg/L,significantly lower than【(327.0±35.6 nmol/L,31.2±2.8 mg/L,352.8±31.5 ng/mL and 111.6±10.3μg/L,respectively),P<0.05】in the control;the percentages of peripheral blood CD3^+,CD4^+and CD8^+ cells were 58.1±5.2%,37.1±4.1%and 28.2±1.7%,all significantly different as compared to(53.2±4.9%,33.6±4.0%and 37.6±3.4%,respectively,P<0.05)in the control.Conclusion Laparoscopic regular hepatectomy or lobectomy has less trauma to patients than open hepatectomy,which might effectively improve the liver functions because of less stress response and low immunosuppressive effect.

关 键 词：复杂性肝内胆管结石 腹腔镜手术 规则性肝段或肝叶切除术 皮质醇 淋巴细胞亚群 

分 类 号：R657.4[医药卫生—外科学]