Griffith J P, Everitt N J, Lancaster F, Boylston A, Richards S J, Scott C S, Benson E A, Sue-Ling H M, McMahon M J
Leeds Institute for Minimally Invasive Therapy, General Infirmary, UK.
Br J Surg. 1995 May;82(5):677-80. doi: 10.1002/bjs.1800820539.
Surgery, trauma and anaesthesia induce a state of transient immunosuppression. Laparoscopic cholecystectomy has several well documented clinical advantages over traditional cholecystectomy and provokes a lower acute phase response, thought to be a result of the smaller wound size. The influence of laparoscopic cholecystectomy (21 patients) and conventional open cholecystectomy (13 patients) upon components of the cell-mediated immune system was investigated. Cell-mediated immunity was studied by in vitro assays of T lymphocyte proliferation to different mitogens, and by natural killer cell cytotoxicity using a standard 51Cr release assay. Blood samples were taken before and 24 h after the start of the operation. In the sample taken after operation there was significant depression of T lymphocyte proliferation to phytohaemagglutinin (stimulation index 149.4 versus 33.3, P < 0.002), staphylococcal enterotoxin B (85.2 versus 52.6, P = 0.01) and toxic shock syndrome toxin (48.4 versus 14.8, P = 0.08) in the group of patients who underwent open surgery, but not in the group treated by laparoscopic surgery. There was a small but statistically insignificant decrease of natural killer cell cytotoxicity in both groups of patients. These findings suggest that laparoscopic cholecystectomy causes less depression of cell-mediated immunity than open cholecystectomy.
手术、创伤和麻醉会引发一种短暂的免疫抑制状态。与传统胆囊切除术相比，腹腔镜胆囊切除术具有多项已充分记录的临床优势，且引发的急性期反应较低，这被认为是伤口较小的结果。研究了腹腔镜胆囊切除术（21例患者）和传统开放性胆囊切除术（13例患者）对细胞介导免疫系统各组成部分的影响。通过体外检测T淋巴细胞对不同有丝分裂原的增殖情况以及使用标准的51Cr释放试验检测自然杀伤细胞的细胞毒性来研究细胞介导免疫。在手术开始前和开始后24小时采集血样。在术后采集的样本中，接受开放性手术的患者组中，T淋巴细胞对植物血凝素的增殖（刺激指数149.4对33.3，P<0.002）、葡萄球菌肠毒素B（85.2对52.6，P=0.01）和中毒性休克综合征毒素（48.4对14.8，P=0.08）均有显著降低，而接受腹腔镜手术的患者组则没有。两组患者的自然杀伤细胞细胞毒性均有小幅下降，但在统计学上无显著意义。这些发现表明，与开放性胆囊切除术相比，腹腔镜胆囊切除术对细胞介导免疫的抑制作用较小。
