Effects of laparoscopic splenectomy and esophagogastric devascularization on stress and immune function in patients with cirrhotic portal hypertension

中华普通外科杂志 Pub Date : 2019-07-25 DOI:10.3760/CMA.J.ISSN.1007-631X.2019.07.016

Kunfu Dai, Shuai Ma, Xiaopei Hao, Yuting He, Tao Zhou, Guangjin Tian, Yadong Dong

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Abstract

Objective To evaluate the effects of laparoscopic splenectomy and esophagogastric devascularization(LSPD) vs. open procedure(OSPD) on stress and immune function in patients with portal hypertension due to cirrhosis. Methods From June 2015 to June 2017 a total of 66 patients underwent LSPD or OSPD procedures. Results Plasma cortisol concentration in the LSPD group was lower than that in the OSPD group (Fgroup=18.85, P=0.020). Cortisol concentration in the two groups increased firstly and then decreased with time extension (Ftime=532.08 , P=0.000). The level of CD3+ , CD4+ , CD4+ /CD8+ in LSPD group was higher than that in OSPD group, and the level of CD8+ was lower than that in OSPD group (Fgroup=3.55, 21.47, 154.84, 64.29, P 38.0 ℃, and >3 days) is OSPD group is higher than in the LSPD group(χ2=5.49, 6.68, P=0.019, 0.010). Conclusion LSPD effectively reduces postoperative stress, protects immune function , decreases postoperative pleural and abdominal effusion and fever. Key words: Hypertension, portal; Hydrocortisone; T-lymphocytes subsets; Splenectomy

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腹腔镜脾切除和食管胃断流术对肝硬化门静脉高压症患者应激和免疫功能的影响

目的探讨腹腔镜脾切除术和食管胃断流术(LSPD)与开放手术(OSPD)对肝硬化门静脉高压症患者应激和免疫功能的影响。方法2015年6月至2017年6月共66例患者行LSPD或OSPD手术。结果LSPD组血浆皮质醇浓度低于OSPD组(f组=18.85,P=0.020)。两组皮质醇浓度随时间延长先升高后降低(Ftime=532.08, P=0.000)。LSPD组CD3+、CD4+、CD4+ /CD8+水平均高于OSPD组，CD8+水平低于OSPD组(f组=3.55、21.47、154.84、64.29,P= 38.0℃、bbb3 d)，且OSPD组高于LSPD组(χ2=5.49、6.68,P=0.019、0.010)。结论LSPD能有效减轻术后应激，保护机体免疫功能，减少术后胸腹积液和发热。关键词:高血压;门静脉;氢化可的松;t淋巴球子集;脾切除术

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中华普通外科杂志

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