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Laparoscopic surgery in patients with liver cirrhosis with gallbladder stones: Effect on immunity and complications
Source:en.cnki.com.cn | Author:youwai | Published time: 2020-02-26 | 1395 Views | Share:
AIM: To study the effect of laparoscopic surgery on immunity and complications in patients with liver cirrhosis and gallbladder stones. METHODS: Eighty patients with liver cirrhosis and gallbladder stones were randomly divided into either an observation group or a control group. Patients in the observation group underwent laparoscopic surgery, and patients in the control group underwent open surgery. Arterial blood samples were taken to determine plasma concentrations of adrenaline, norepinephrlne and dopamine. Intraoperative blood loss, operative time, flow rate, and length of hospital staywere recorded. C-reactive protein(CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α),and T lymphocyte subsets(CD4, CD8) were determined. RESULTS: Intraoperative blood loss, operative time, postoperative flow and drainage time, anal exhaust time and hospital stay in the observation group were significantly lower than those in the control group(165.84 mL ±50.23mL vs 240.33 mL ± 150.56 mL, 91.78 min ±21.74 min vs 137.94 min ± 30.55 min, 274.37 mL± 121.15 mL vs 418.53 mL ± 132.24 mL, 2.34 d ±1.46 d vs 5.72 d ± 1.84 d, 1.33 d ± 0.73 d vs 2.73 d± 1.33 d, 8.43 d ± 1.24 d vs 11.54 d ± 3.22 d, P 0.05 for all). The levels of CRP, IL-6 and TNF-αin the observation group were significantly lower than those in the control group(6.13 mg/L ± 1.64 mg/L vs 14.24 mg/L ± 2.52 mg/L, 9.44pg/mL ± 1.65 pg/mL vs 12.82 pg/mL ± 1.54pg/mL, 10.42 pg/mL ± 1.64 pg/mL vs 19.83pg/mL ± 1.53 pg/mL, P 0.05 for all). Preoperatively, there were no significant differences in the percentages of CD4+ and CD8+ lymphocytes or CD4/CD8 ratio between the observation group and control group(42.53% ± 4.63%vs 42.42% ± 4.64%, 29.32% ± 2.44% vs 29.13% ±2.64%, 1.65 ± 0.26 vs 1.66 ± 0.24, P 0.05 for all).On postoperative days 1 and 3, the percentages of CD4+ and CD8+ lymphocytes and CD4/CD8ratio were significantly higher in the observation group than in the control group(day 1:33.22% ± 2.52% vs 28.24% ± 2.74%, 19.83% ±2.53% vs 14.24% ± 2.52%, 1.11 ± 0.23 vs 0.73 ±0.33, P 0.05 for all; day 3: 39.42% ± 2.64% vs34.12% ± 2.34%, 24.44% ± 2.65 vs 19.82% ± 2.54%,1.43 ± 0.24 vs 1.04 ± 0.22, P 0.05 for all). The percentages of CD4+ and CD8+ lymphocytes and CD4/CD8 ratio were significantly higher on postoperative days 1 and 3 in both groups compared with preoperative values(P 0.05for all). The percentages of patients developing infection and hypoalbuminemia were significantly lower in the observation group than in the control group(7.5% vs 25.0%, 10.0% vs30.0%, P 0.05). The incidence of blood coagulation dysfunction did not differ significantly between the two groups(20.0% vs 25.0%, P 0.05). CONCLUSION: Compared with open surgery,laparoscopic surgery is associated with less trauma, more rapid recovery, lower effect on immune function and response, and lower incidence of adverse reactions in patients with liver cirrhosis and gallbladder stones.