Schietroma M, Risetti A, Carlei F, Cianca G, Mattucci S, Maggi G, Recchia C L, De Santis C, Simi M
Cattedra di Chirurgia Generale, Università degli Studi, L'Aquila.
Chir Ital. 1996;48(4):27-31.
Recent clinical studies suggest that laparoscopic cholecystectomy (LC) causes less depression of cell-mediated immunity than open cholecystectomy. LC is a so called "mini invasive" surgical presidia, and on the basis of this consideration we have investigated if and how the immune response is modified in patients with acute cholecystitis after laparoscopic cholecystectomy compare to patients undergone open cholecystectomy. Immune-activity (neutrophils, total lymphocytes count, lymphocytes subpopulations, HLA-DR, 6-Interleukin, skin multitests) was evaluated in 28 patients 24-36 hours before surgery and p.o. after 1, 3 and 6 days: 16 patients underwent "open" cholecystectomy and 12 LC. One day after surgery patients with open cholecystectomy showed significant increase (p < or = 0.05) of plasma neutrophils and 6-Interleukin, while these parameters were almost unchanged in patients with LC. Moreover, skin tests showed ipo or anergic response in the majority (81.8%) of patients with "open" surgery compare to patients with LC (10.5%): (p < or = 0.05). Finally monocyte antigen HLA-DR was also reduced in patients with "open" cholecystectomy: in this group we also recorded 2 cases (12.5%) of respiratory tract infection. In conclusion, LC for acute cholecystitis, avoids p.o. immunosuppression with better p.o. morbidity compare to open surgery.
近期临床研究表明，与开腹胆囊切除术相比，腹腔镜胆囊切除术（LC）对细胞介导免疫的抑制作用较小。LC是一种所谓的“微创手术”方式，基于这一考虑，我们研究了与接受开腹胆囊切除术的患者相比，急性胆囊炎患者在接受腹腔镜胆囊切除术后免疫反应是否以及如何发生改变。在28例患者手术前24 - 36小时及术后第1、3和6天口服给药后评估免疫活性（中性粒细胞、淋巴细胞总数、淋巴细胞亚群、HLA - DR、6 - 白细胞介素、皮肤多项试验）：16例患者接受“开腹”胆囊切除术，12例接受LC。开腹胆囊切除术患者术后1天血浆中性粒细胞和6 - 白细胞介素显著增加（p≤0.05），而LC患者这些参数几乎未变。此外，与LC患者（10.5%）相比，“开腹”手术患者中大多数（81.8%）皮肤试验显示口服给药后无反应或无变应性反应（p≤0.05）。最后，“开腹”胆囊切除术患者单核细胞抗原HLA - DR也降低：在该组中我们还记录到2例（12.5%）呼吸道感染病例。总之，对于急性胆囊炎，与开腹手术相比，LC可避免口服给药后的免疫抑制，且口服给药后的发病率更低。
