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目的:探讨行悬吊式与气腹腹腔镜子宫切除术对淋巴细胞免疫的影响。方法:选择该院2006年7月～2008年2月生殖健康科收治的行腹腔镜下子宫切除术的患者共75例,随机分成两组,气腹组40例,于静脉全麻下行CO2气腹腹腔镜手术;悬吊组35例,于静脉全麻下行悬吊式腹腔镜手术。采用EPICS ELITE/ESP流式细胞仪监测两组患者麻醉前、术后次日和4天晨7时外周血CD3、CD4、CD8 T淋巴细胞亚群的浓度。结果:麻醉前两组患者CD3、CD4、CD8 T淋巴细胞亚群的浓度差异无统计学意义(P>0.05)。在气腹组,术后第l天CD3、CD4均明显低于术前水平(P<0.01),于术后第4天CD3、CD4仍未恢复到术前水平(P<0.05);而CD8和CD4/CD8于手术后第1天轻度下降(P<0.05),但于术后第4天已恢复正常。悬吊组于术后第1天,CD3、CD4、CD8与术前相比均有轻度下降(P<0.05),于术后第4天所有指标均已恢复正常水平,而CD4/CD8于手术前后无明显变化(P>0.05)。两组比较,气腹组患者在术后第1天的CD3、CD4、CD8、CD4/CD8均显著低于悬吊组,术后第4天气腹组CD3仍低于悬吊组,其余指标无显著性差异。结论:悬吊式腹腔镜技术免除了CO2气腹对机体的影响,保护了机体的免疫功能,有利于机体抵御各种有害因素的侵袭,显示了悬吊式腹腔镜手术的优越性。
Objective: To investigate the effects of laparoscopic and pneumoperitoneal laparoscopic hysterectomy on lymphocyte immunity. Methods: A total of 75 patients undergoing laparoscopic hysterectomy admitted to the Department of Reproductive Health from July 2006 to February 2008 were randomly divided into two groups: 40 patients in the pneumoperitoneum group, and received CO2 gas under general anesthesia Laparoscopic surgery; suspension group of 35 patients underwent general anesthesia underwent laparoscopic surgery. EPICS ELITE / ESP flow cytometry was used to monitor the concentration of CD3, CD4 and CD8 T lymphocyte subsets in peripheral blood before anesthesia, on the next day after surgery and at 7:00 on the 4th day. Results: There was no significant difference in the concentration of CD3, CD4, CD8 T lymphocyte subsets between the two groups before anesthesia (P> 0.05). In the pneumoperitoneum group, CD3 and CD4 were significantly lower than preoperative levels on the first postoperative day (P <0.01), and CD3 and CD4 did not recover to the preoperative level on the fourth postoperative day (P <0.05) And CD4 / CD8 decreased slightly on the first postoperative day (P <0.05), but returned to normal on the fourth postoperative day. On the first postoperative day, the numbers of CD3, CD4 and CD8 in the suspension group decreased slightly compared with that before operation (all P <0.05), and all the indexes returned to the normal level on the 4th postoperative day No significant changes before and after surgery (P> 0.05). The pneumoperitoneum group had significantly lower CD3, CD4, CD8 and CD4 / CD8 on the first postoperative day than those in the suspension group. On the fourth postoperative day, the CD3 in the pneumoperitoneum group was still lower than that in the suspension group. The remaining indexes Significant difference. Conclusion: Laparoscopic technique avoids the influence of pneumoperitoneum on the body, protects the body’s immune function, helps the body to resist the invasion of various harmful factors, and shows the superiority of hanging laparoscopic surgery.