Effect Of Laparoscopy On Stress And Immune Function In Patients

Objective: To study the effect of laparoscopy on stress and immune function in patientsMethods: Seventy-eight patients were selected to undergo laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) from 2001 september to 2002 september in hepatobiliary department of our hospital. All cases were chronic gallbladdertitis, 31 of them were male, 47 cases were female. Diseases were gallbladder stone (62 cases, 79.5%) and gallbladder polyps (16 cases, 20.5%). 59 cases underwent LC, the others were operated on using the open technique. Patients underwent LC were devided into 3 groups, 16 cases belong to A group (operative time was less than 30 minutes), 26 cases belong to B group (operative time was from 30 to 60 minutes), 17 cases belong to C group (operative time exceed 60 minutes). All LC were performed under same equipments and conditions. Each operation was performed by general anesthesia. There were no serious complications. All patients' Blood was sampled to measure stress markers (CRP,Glu,IL-6,WBC,N) and immune markers (immune globulin IgA,IgG,IgM,complement C3,C4) before operation and the second morning after operation. We observed the change of stress and immune markersbefore and after operation, the effect of stress and immune by LC and OC, the effect of stress and immune caused by sex,age,disease,operative methods and operative time of LC.We compare the stress and immune markers between preoperation and postoperation of LC, LC and OC, between A, B and C groups of LC . We also compare the effect of stress and immune function caused by sex, age, disease and operative time. SAS 8.2 statistical software was used to analysis these data.Results:1. The postoperative stress and immune markers of LC did not changed significantly than those before the operation (P>0.05) by partner t test, except WBC(it incresed significantly after operation, P<0.01).2. The postoperative markers of CRP,BG and IL-6 increased significantly, While IgA,IgG,IgM decreased significantly after OC than those after LC(P<0.01). The postoperative markers of C3,C4 were similar in LC and OC(P>0.05). The difference of WBC was significant(0.010.05) by analysis of variance. There was no significant difference in age, sex or disease.4. The markers of stress and immune in different groups devided by operative time of LC were not different significantly(P>0.05)by analysis ofvariance.Conclusions:1. The stress responses after LC were significantly reduced when compared with those after OC, so the immune function was effected faintly after LC.2. The operative method was key factor in all factors effecting stress and immune function.3. According to laparoscopic cholecystectomy, operative time effect stress and immune function faintly under same anaesthesia methods and carbon dioxide pneumoperitoneum pressure.4. The effect of laparoscopy in patients don't localize in stress and immune function, it also include effect of body's circulation and breathing produced by carbon dioxide pneumoperitoneum. It is a compositive results.