Walker C B, Bruce D M, Heys S D, Gough D B, Binnie N R, Eremin O
Department of Surgery, University of Aberdeen, Foresterhill, Scotland.
Am J Surg. 1999 Jan;177(1):48-54. doi: 10.1016/s0002-9610(98)00290-6.
Trauma, whether accidental or surgically induced, is known to cause significant modulation of the cell-mediated immune response. Minimal access surgery (MAS) has been shown to improve postoperative recovery and enhance rehabilitation. The degree of immunosuppression resulting from two MAS techniques was studied and compared by measuring the circulating T lymphocyte and natural killer (NK) cell subsets.
This investigation was a randomized prospective study of patients admitted to the Professorial Surgical Unit, Aberdeen Royal Infirmary for elective cholecystectomy. Two methods of MAS were studied-laparoscopy and minilaparotomy.
Laparoscopy was found to cause significantly less reduction in the number of cells expressing T lymphocyte phenotypic surface markers (CD2, CD3, CD8, CD4:CD8 ratio), activation markers (CD71 and HLA-DR), and NK cell subsets (CD11b, CD16, CD56 and CD57), when compared with the minilaparotomy technique.
These data show that host defences are less suppressed after laparoscopic cholecystectomy, and this may have important implications for the use of laparoscopic techniques in major surgical resections, especially for malignant disease.
创伤，无论是意外创伤还是手术引起的创伤，已知会导致细胞介导的免疫反应发生显著调节。微创手术（MAS）已被证明可改善术后恢复并促进康复。通过测量循环T淋巴细胞和自然杀伤（NK）细胞亚群，对两种MAS技术导致的免疫抑制程度进行了研究和比较。
本研究是对入住阿伯丁皇家医院教授级外科病房接受择期胆囊切除术患者的一项随机前瞻性研究。研究了两种MAS方法——腹腔镜手术和小切口开腹手术。
与小切口开腹手术技术相比，发现腹腔镜手术导致表达T淋巴细胞表型表面标志物（CD2、CD3、CD8、CD4:CD8比率）、活化标志物（CD71和HLA-DR）以及NK细胞亚群（CD11b、CD16、CD56和CD57）的细胞数量减少明显较少。
这些数据表明，腹腔镜胆囊切除术后宿主防御功能受到的抑制较小，这可能对在大型手术切除中，尤其是恶性疾病手术中使用腹腔镜技术具有重要意义。
