中华消化内镜杂志
中華消化內鏡雜誌
중화소화내경잡지
CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY
2012年
10期
577-580
,共4页
方兰%黎朝良%王斌%李彩丽%孙泽群
方蘭%黎朝良%王斌%李綵麗%孫澤群
방란%려조량%왕빈%리채려%손택군
胆总管结石%括约肌切开术,内窥镜%剖腹术%急相反应%免疫
膽總管結石%括約肌切開術,內窺鏡%剖腹術%急相反應%免疫
담총관결석%괄약기절개술,내규경%부복술%급상반응%면역
Choledocholithiasis%Sphincterotomy,endoscopic%Laparotomy%Acute-phase reaction%Immunity
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(CD4、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±0.11) 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]水平明显高下开腹组[ (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1d CD4 、CD8水平及CD4/CD8比值较术前仅轻度下降(P均＞0.05),且术后5 d均恢复至术前水平,而开腹组术后CD4、CD8水平及CD4/CD8比值较术前显著下降(P均＜0.05),术后两组间的差异明显(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疗反应,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.
目的 探討內鏡下乳頭括約肌切開取石術與開腹膽道探查術對機體炎癥反應和免疫功能的影響.方法 將2010年6月至2012年2月共51例膽總管結石患者按其意願分為內鏡治療組(內鏡組,24例)和開腹手術組(開腹組,27例),比較兩組患者圍手術期外週血降鈣素原、C反應蛋白、免疫毬蛋白( IgA、IgG、IgM)及T淋巴細胞亞群(CD4、CD8、CD4/CD8比值)的變化.結果 術後內鏡組和開腹組患者的降鈣素原[(8.05±2.98) μg/L和(5.42±1.57) μg/L],C反應蛋白[(62.0±15.49) mg/L和(45.73±12.65) mg/L]均較術前[(0.56±0.14) μg/L和(0.60±0.11) μg/L,(9.39 ± 3.27) mg/L和(9.22±3.12) mg/L]明顯升高(P均＜0.01),且兩組的降鈣素原、C反應蛋白水平差異有統計學意義(P均＜0.05),但術後3d、5d兩組的差異即無統計學意義(P均＞0.05).術後兩組患者的免疫毬蛋白水平均較術前顯著降低(P均＜0.05),但內鏡組IgA[( 1.08±0.36) g/L]、IgM[(0.92±0.23) g/L]水平明顯高下開腹組[ (0.60 ±0.23 )g/L,(0.60±0.11)g/L](P均＜0.05),術後兩組的IgG水平無顯著差異(P均＞0.05).內鏡組術後1d CD4 、CD8水平及CD4/CD8比值較術前僅輕度下降(P均＞0.05),且術後5 d均恢複至術前水平,而開腹組術後CD4、CD8水平及CD4/CD8比值較術前顯著下降(P均＜0.05),術後兩組間的差異明顯(P＜0.05).結論 內鏡下乳頭括約肌切開取石術與開腹膽道探查術均可誘髮患者炎療反應,抑製機體的免疫功能；但內鏡下乳頭括約肌切開取石術對機體的免疫功能影響更小,且可能主要影響體液免疫,而短時間內誘髮的急性炎癥反應更為彊烈.
목적 탐토내경하유두괄약기절개취석술여개복담도탐사술대궤체염증반응화면역공능적영향.방법 장2010년6월지2012년2월공51례담총관결석환자안기의원분위내경치료조(내경조,24례)화개복수술조(개복조,27례),비교량조환자위수술기외주혈강개소원、C반응단백、면역구단백( IgA、IgG、IgM)급T림파세포아군(CD4、CD8、CD4/CD8비치)적변화.결과 술후내경조화개복조환자적강개소원[(8.05±2.98) μg/L화(5.42±1.57) μg/L],C반응단백[(62.0±15.49) mg/L화(45.73±12.65) mg/L]균교술전[(0.56±0.14) μg/L화(0.60±0.11) μg/L,(9.39 ± 3.27) mg/L화(9.22±3.12) mg/L]명현승고(P균＜0.01),차량조적강개소원、C반응단백수평차이유통계학의의(P균＜0.05),단술후3d、5d량조적차이즉무통계학의의(P균＞0.05).술후량조환자적면역구단백수평균교술전현저강저(P균＜0.05),단내경조IgA[( 1.08±0.36) g/L]、IgM[(0.92±0.23) g/L]수평명현고하개복조[ (0.60 ±0.23 )g/L,(0.60±0.11)g/L](P균＜0.05),술후량조적IgG수평무현저차이(P균＞0.05).내경조술후1d CD4 、CD8수평급CD4/CD8비치교술전부경도하강(P균＞0.05),차술후5 d균회복지술전수평,이개복조술후CD4、CD8수평급CD4/CD8비치교술전현저하강(P균＜0.05),술후량조간적차이명현(P＜0.05).결론 내경하유두괄약기절개취석술여개복담도탐사술균가유발환자염료반응,억제궤체적면역공능；단내경하유두괄약기절개취석술대궤체적면역공능영향경소,차가능주요영향체액면역,이단시간내유발적급성염증반응경위강렬.
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 、lgG 、IgM ) and T lymphocyte (CD4、CD8 ) of peripheral blood were examined 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 levels of these variables in LG were decreased significantly ( P ＜ 0.05).Postoperative levels of CD4,CD8 and CD4/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.
