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目的:研究妇科腹腔镜手术对机体免疫功能的影响,为腹腔镜手术微创性提供更多的理论依据。方法:选择83例子宫肌瘤、卵巢良性畸胎瘤、卵巢上皮性肿瘤及卵巢子宫内膜异位囊肿患者,其中腹腔镜组(LS组)43例,开腹手术组(OS组)40例,比较两组围手术期一般状况、手术前后白细胞(WBC)数、中性粒细胞(NEU)数、白细胞介素2、4(IL-2,IL-4)及免疫球蛋白IgA、IgG、IgM的水平。结果:①两组术后第1天血WBC数和NEU数较术前均明显升高(P<0.05),且开腹组较腹腔镜组升高幅度大(P<0.05),术后第4天均恢复到术前水平(P<0.05)。②两组术后第1天IL-2均明显降低,开腹组下降幅度大(P<0.05),术后第4天腹腔镜手术组逐渐恢复,而开腹手术组仍明显低于术前,两组间差异有统计学意义(P<0.05)。两组术后第1天IL-4均明显升高(P<0.05),且开腹组较腹腔镜组升高幅度程度大(P<0.05),术后第4天腹腔镜已恢复到术前水平,开腹组仍明显高于术前,两组间差异有统计学意义(P<0.05)。③免疫球蛋白IgA、IgM在术前、术后两组均无明显变化(P>0.05),两组免疫球蛋白IgG术后均明显下降(P<0.05),且两组间差异有统计学意义(P<0.05)。④与开腹手术相比,腹腔镜手术时间短、术中出血量少、术后排气时间短、术后病率低。结论:对于妇科良性疾病,在掌握好手术适应证的前提下,腹腔镜手术与开腹手术相比,对机体免疫功能抑制作用小,有利于术后患者的恢复。
Objective: To study the effect of gynecological laparoscopic surgery on immune function and to provide more theoretical basis for minimally invasive laparoscopic surgery. Methods: A total of 83 patients with uterine fibroids, benign ovarian teratoma, ovarian epithelial tumors and ovarian endometriosis were selected. Among them, 43 patients underwent laparoscopic surgery (LS group), 40 patients underwent laparotomy (OS group) (WBC), number of neutrophils (NEU), IL-2, IL-4 and IgA, IgG, IgA and IgG in the two groups were compared before and after operation. IgM levels. Results: ① The blood WBC count and number of NEU on the first day after operation in both groups were significantly higher than those before operation (P <0.05), and were significantly higher in the laparotomy group than those in the laparoscopic group (P <0.05) 4 days to return to the preoperative level (P <0.05). ② The IL-2 in the two groups were significantly decreased on the first day after operation, the decrease was significant in the open group (P <0.05), and the laparoscopic operation group recovered gradually on the fourth day after operation, while the open operation group was still significantly lower than the preoperative , The difference between the two groups was statistically significant (P <0.05). The levels of IL-4 on the first day after operation in both groups were significantly increased (P <0.05), and the extent of increase was higher in the open group than in the laparoscopic group (P <0.05). Laparoscopy was restored to the fourth day after operation Before the level of open group was still significantly higher than preoperative, the difference between the two groups was statistically significant (P <0.05). (3) Immunoglobulin IgA and IgM had no significant difference between the two groups before and after operation (P> 0.05), IgG immunoglobulin in both groups decreased significantly after operation (P <0.05), and the difference between the two groups was statistically significant Significance (P <0.05). ④ Compared with laparotomy, laparoscopic surgery time is short, less blood loss, postoperative exhaust time is short, postoperative morbidity is low. Conclusion: For gynecological benign diseases, under the premise of mastering the indications for surgery, laparoscopic surgery has less inhibitory effect on the immune function compared with laparotomy, which is in favor of postoperative recovery.