| Objective:To investigate the effect of laparoscopic operation on body stressand immune function in patients with gallbladder stone complicated with acute cholecystitis.Methods:103 cases of patients with gallbladder stone complicated with acute cholecystitis in department of general surgery of our hospital from June 2013 to June 2015 were randomly selected and according to the random digital table method,divided into laparoscopic operation surgery and traditional surgery group.There were 56 cases in laparoscopic surgery group,and 47 cases in traditional open surgery group.All patients were given the same preoperative preparation, both laparoscopic and traditional surgerywere were respectively performed within 72 h underwent laparoscopic cholecystectomy. Operation time, intraoperative blood loss, incision length, postoperative bed activity time and hospitalization timein operative process of two groups were observed.In addition, 1,3 and 7 days before and after operation, the body stressindexes such as IL-6, CRP, cortisol and ACTH, and blood sugar were observedin two groups,and at each timepoint the indexes of T lymphocyte subsets(CD4, CD8, CD3 and CD4/CD8), NK cell number, immunoglobulin(Ig M, Ig G, Ig A), complement(C3, C4) and other immune functions of patients in two groups were observed.All patients were reviewed 3 months after surgery. The scar lengthand complications were observed and compared. The lifequality of patients were evaluated by lifequality of questionnaire.Results:(1)There were no significant difference in serum IL-6, CRP, cortisol, ACTH, and blood glucose levels in two groups before operation(P>0.05),and on 1st day, 3rd,days and 7th days after operation, their levels in the laparoscopic operation group were significantly lower than those in traditional surgery group(P<0.05).And compared with those before operation, IL-6, CRP, cortisol, ACTH, and blood glucose levels on 1stday and 3rd days in laparoscopic operation group,and all the indexes in the traditional surgery group were significantly higher(P<0.05).All indexed in two group decreased when compared with those on 1st day after operation(P<0.05).Compared with those on 3rd days after operation,IL-6, cortisol and blood glucose in the laparoscopic surgery group and all the indexes in the traditional surgery group were significantly lower(P<0.05).(2)There were no significant difference in CD3, CD4, CD8, CD4/CD8,NK cell numbers, Ig A, Ig M, Ig G, C3, C4 in two groups before operation(P>0.05),and the differences of all the indexes in two groups after operation were statistically significant on 1st day after operation(P<0.05).And the difference of CD3, CD4, CD8, CD4/CD8,NK cell numbers, Ig A, Ig M, Ig G, C3 on 3rd day after operation were statistically significant(P<0.05).And the difference of CD3, CD4, CD4/CD8, C47 th day after operation were statistically significant(P<0.05).Compared with the same group,and compared with those before operation,the difference in number of NK cell on 1st day after operation,CD3, CD4, Ig A, Ig M, Ig G, C3 on 1st day and 3rd day in the laparoscopic operation group,and the CD4/CD8 on 1st day after operation,CD8, NK cell numbers, Ig A, Ig M, Ig G, C3 on 1st day and 3rd day,CD3, CD4 on 1st day,3rd day and 7th day after operation in the traditional surgery group were statistically significant(P<0.05). Compared with those on 1st day after operation,the difference of the NK cell number on 7th days after operation,the CD3, CD4, Ig A, Ig M, Ig G, C3 on 3rd day and 7th day after operation in the laparoscopic operation group,and the CD4/CD8 at the moment of 7 days after oper- ation,the CD3, CD4, CD8,NK cell numbers, Ig A, Ig M, Ig G, complement C3 at the moments of 3 days and 7 days after operation were statistically significant(P<0.05). Compared with those at the moment of 3 days after operation,the differences in the CD3, CD4, Ig A, Ig M, Ig G at the moment od 7 days in the laparoscopic operation surgery group, and the CD3, CD4, CD8,NK cell numbers, Ig A, Ig M, Ig G were statistically significant(P<0.05).(3)The operation time of laparoscopic operation group was significantly longer than the traditional operation group(P< 0.05),while blood loss and the length of incision were significantly decreased(P<0.05),and postoperative bed activity time and hospitalization time of the former was longer than those of the latter(P<0.05).(4)The length of scar at the moment of 3 months after operation of the laparoscopic surgery group was significantly shorter than that of the traditional surgery group(P<0.05).And the complication rate of laparoscopic surgery group was about 3.57%, while the traditional operation group was about 19.15%, and the difference between the two groups was statistically significant(P<0.05).(5)The physiological functions, role limitations, physical pain, general health, vitality, social function, emotional function, mental health and other dimensions of life quality scores of the laparoscopic surgery group were significantly higher than those of the traditional surgery group at the moments of 3 months after operation,and the differences were statistically significant(P<0.05),and the overall lifequality score of the former was significantly higher than that of the latter,and the difference was statistically significant(P<0.05).Conclusion:Laparoscopic cholecystectomy in the treatment of patients with acute cholecystitis with gallbladder stones has better effect,which can not only improve the levels of serum IL-6, CRP, cortisol, ATCH, blood glucose level and other trauma stress index,but also has stable effect on the CD3, CD4, CD8, CD4/CD8,NK cell numbers, Ig A, Ig M, Ig G, complement C3, C4 of the immunity.The bleeding volume, the length of the incision, postoperative bed activity time and hospitalization time, postoperative complications, postoperative life quality scores are significantly improved compared with the traditional surgery.Both methods have certain advantages and disadvantages.In the course of the operation determination,the operation plan should be determined according to the patient’s condition and the actual situation. |
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