天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (6): 772-775.doi: 10.11958/20150273

• 临床研究 • 上一篇    下一篇

腹腔镜和开腹修补术对老年上消化道溃疡穿孔患者PCT 及细胞免疫影响的比较

王庚壮 1， 赵志荣 2， 潘立峰 1   

  1. 1天津医科大学附属第四临床学院普外一科 （邮编300140） ,2医务科
  • 收稿日期:2015-10-30 修回日期:2016-03-23 出版日期:2016-06-15 发布日期:2016-07-04

A comparative study of laparoscopic neoplasty and open neoplasty on levels of procalcitonin and cell-mediated immunity in elderly patients with upper digestive tract ulcer perforation

WANG Gengzhuang1, ZHAO Zhirong2, PAN Lifeng1   

  1. 1 Department of General Surgery, 2 Medical Department, the Forth Affiliated Clinical Hospital of Tianjin Medical University, Tianjin 300140, China
  • Received:2015-10-30 Revised:2016-03-23 Published:2016-06-15 Online:2016-07-04

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摘要： 摘要： 目的 探讨老年上消化道溃疡穿孔腹腔镜修补手术的效果， 及手术前后降钙素原（PCT）及细胞免疫功能的变化特点。方法 选取 44 例老年上消化道溃疡穿孔行修补手术患者， 其中腹腔镜组 20 例， 开腹组 24 例， 分别于术前 0.5 h 和术后 24 h、 48 h、 第 7 天抽取患者空腹静脉血， 采用胶体免疫结合法测定 PCT， 流式细胞仪测定 T 淋巴细胞亚群 （CD3+、 CD4+、 CD8+） 及自然杀伤 （NK） 细胞水平。观察 2 组手术并发症、 术后住院时间。结果 术前腹腔镜组与开腹组血清 PCT 差异无统计学意义； 2 组患者术前 0.5 h CD3+、 CD4+、 CD8+水平和 NK 细胞活性差异均无统计学意义； 术后 24 h、 48 h 腹腔镜组 PCT 水平均低于开腹组 （P＜0.05）； 腹腔镜组与开腹组 CD3+、 CD4+、 CD8+、 NK 细胞随时间变化差异有统计学意义（P＜0.05）； 术后 24 h 2 组 CD3+、 CD4+、 CD8+较术前均明显降低， 且除 CD8+外， 开腹组均低于腹腔镜组， 差异均有统计学意义； 术后 48 h 腹腔镜组 CD3+、 CD4+、 CD8+恢复至术前水平， 而开腹组患者 CD3+术后第 7 天仍未恢复至术前水平； 术后 24 h 2 组 NK 细胞较术前降低， 2 组间比较差异无统计学意义； 术后 48 h 腹腔镜组 NK 细胞恢复至术前水平， 开腹组 NK 细胞与术前相比差异亦无统计学意义； 与开腹组相比， 腹腔镜组术后并发症少， 术后住院时间短。结论 腹腔镜上消化道溃疡穿孔修补手术对老年患者机体应激反应及免疫功能影响较小， 在免疫功能保护上具有优势。

关键词: 消化性溃疡穿孔, 腹腔镜检查, 免疫, 细胞, T 淋巴细胞亚群, 杀伤细胞, 天然, 降钙素原

Abstract: Abstract：Objective To study the effect of laparoscopic neoplasty and changes of procalcitonin (PCT) and cellmediated immunity in elderly patients with duodenal ulcer perforation. Methods Forty-four elderly patients with duodenal ulcer perforation were divided into laparoscopic neoplasty group (n=20) and open neoplasty group (n=24)．The level of PCT was assayed by colloid immunization. Blood levels of CD3+, CD4+, CD8+ and natural killer (NK) cells were detected by flow cytometry before operation and at 0.5 h, 24 h, 48 h and the 7th day after operation．Surgical complications and postoperative hospital stay were observed in two groups. Results There was no significant difference in the activity of PCT before operation between two groups. There were no significant differences in CD3 + , CD4 + , CD8 + and NK cells 0.5 h before operation between two groups. The level of PCT was significantly lower at 24 h and 48 h after operation in laparoscopic group than that in open operation group (P< 0.05). There were significant differences in the serum levels of CD3+, CD4+, CD8+ and NK cells with time changes in two groups (P＜0.05). There were significant decreases in CD3+, CD4+ and CD8+ at 24 h after operation than those before operation in two groups, which were significantly lower in open operation group than those of laparoscopic group except for CD8+. The levels of CD3+, CD4 + and CD8+ recovered to the levels before operation at 48 h after operation in laparoscopic group. In open operation group CD3+ did not return to the level before operation at 7 d after operation. The levels of NK cells were decreased at 24 h after operation in two groups, but there was no significant difference in the level of NK cells between two groups. The level of NK cells returned to preoperative levels at 48 h after operation inlaparoscopic group, while there was no significant difference in the level of NK cells before and after operation in open neoplasty group. Compared with the open neoplasty group, there were fewer complications and shorter hospital stay in laparoscopic group. Conclusion The laparoscopic repair operation for gastric and duodenal ulcer perforation has a fewer effects on the stress response and immune function in elderly patients, and has the advantages in the protection of immune function.

Key words: peptic ulcer perforation, laparoscopy, immunity, cellular, T- lymphocyte subsets, killer cells, natural, procalcitonin