The Influence Of Laparoscopic Common Bile Duct Exploration And Open Surgery On Immune Function

Objective To investigate immune function of the peripheral blood immune globulin, complement levels and lymphocytes immune in laparoscopic common bile duct exploration surgery. To study the influence of laparoscopic common bile duct exploration on immune system.Methods The immune nephelometry and flow cytometry common bile duct stones in patients with 80 patients (divided into laparoscopic common bile duct exploration, open common bile duct exploration of 40 cases) and peripheral blood Immune globulin (IgG, IgA, IgM), complement C3, C4 levels, T lymphocyte antigen (CD3, CD4, CD8), B lymphocyte antigen (CD 19) and NK cells (CD 16+56) and other immune parameters changes, and 80 cases of mains stone patients, including 40 cases of laparoscopic common bile duct exploration (laparoscopic common bile duct exploration, LCBDE), 40 cases of open common bile duct exploration (common bile duct exploration, CBDE), as well as before and after surgery comparison before and after the various indicators.Results 1. Postoperative levels of serum complements of LCBDE group and CBDE group were lower than preoperative levels in patients with common bile duct stones. Each postoperative index compared with the preoperative had no difference in LCBDE (P> 0.05). But the level of serum C3 postoperative day 1, day 4 was significantly decreased compared with preoperation in CBDE, and the difference was statistically significant (P<0.05). Moreover the level of serum C3 after CBDE more significantly decreased than LCBDE, and the difference was statistically significant (P<0.01); 2. Postoperative levels of serum immunoglobulin of LCBDE group and CBDE group were lower than preoperative levels. Each postoperative index compared with the preoperative had no difference in LCBDE (P> 0.05). But the level of serum immunoglobulin postoperative day 1, day 4 was significantly decreased compared with preoperation in CBDE, and the difference was statistically significant (P<0.05). Moreover the level of serum immunoglobulin after CBDE more significantly decreased than LCBDE, and the difference was statistically significant (P<0.01); 3. The levels of CD3, CD4, CD8, CD4/CD8 of LCBDE in the first postoperative day were only slightly decreased and significantly recovered in 4th postoperative day. The difference was not statistically significant (P>0.05). Postoperative levels of serum CD8 of CBDE was little decreased than preoperation, and the difference was not statistically significant (P>0.05). Postoperative levels of serum CD3, CD4, CD4/CD8 of CBDE were more significantly decreased than preoperation, and the differences were statistically significant (P>0.05). The differences of groups were statistically significant (P<0.01); 4. The level of CD 19 of LCBDE in the first postoperative day was only slightly decreased and recovered to bascically normal in the 4th postoperative day. The difference was not statistically significant (P>0.05). The level of CD19 after CBDE were only slightly decreased and the difference was not statistically significant (P>0.05). The differences of groups were statistically significant (P<0.01); 5. The level of CD (16+56) of LCBDE in the first postoperative day was only slightly decreased and recovered significantly. The difference was not statistically significant (P>0.05). The level of CD (16+56) after CBDE were only slightly decreased and the difference was not statistically significant (P>0.05). The differences of groups were statistically significant (P<0.01).Conclusion 1. LBCDE can result in depressed immune function, and BCDE compared to the extent of its impact, quick recovery, indicating that LBCDE on immune function is less than CBDE, also shows that LBCDE trauma and disruption of the body is small. LBCDE application can help reduce the incidence of infectious complications.2. Application of the immune nephelometry and flow cytometry detection of common bile duct stones in patients with immune function, allow us to better understand the preoperative and postoperative status of immune function, strengthen the perioperative protection; also by monitoring degree of postoperative recovery of immune function to evaluate outcome.