Discuss The Effect On Postoperative Inflammatory Stress Response And Immune Function Of Laparoscopic Hepatectomy

ObjectiveTo compare effect of laparoscopic hepatectomy(LH)and open hepatectomy(OH)on stress inflammation response and immune function of patients,and to analyze the risk factors of postoperative inflammatory stress response and immune function,to explore the mechanism of the minimally invasive laparoscopic hepatectomy Methods24 patients treated with laparoscopic hepatectomy and 24 patients underwent open hepatectomy(including hepatic carcinoma,hepatic hemangioma,hepatolithiasis)were enrolled,which were from the first affiliated hospital of nanchang university general surgery the same treatment group.the research used nonrandomized controlled study methods.comparing the clinical date of two groups,which included preoperative data,perioperative stress index(including c-reactive protein,glucose,white blood cells,neutrophil to lymphocyte ratio,platelet to lymphocyte ratio),immune function index(C3,C4 and lymphocyte),liver function index(ALT,AST,DBIL),intraoperative date(including operation time,blood loss,hepatic portal occlusion),postoperative recovery date and complications.ResultsThere were no significantly difference of operation time and surgical removal liver tissue(P > 0.05).blood loss of LH group and OH group respectively were223±62 ml,286±65 ml,but there was significantly difference(P < 0.05).anal exhaust time of LH group and OH group were respectively 2.6±0.5 days,3.8±0.9 days,postoperative hospital stay of LH group and OH group were respectively 6.2±1.5days,8.9±2.1 days,which of LH group was significant shorter than time of OH group(P < 0.05).complications of LH group and OH group were 4 and 8 cases,which was no significant difference(P > 0.05).The levels of blood glucose,WBC,NLR,PLR and CRP in LH and OH groups were significantly higher than those before operation(P <0.05)and reach to the peakat postoperative 1th day;stress index which belong to LH group was significantly lower than that of OH group,in addition to blood glucose and PLR at postoperative1th?3th day and NLR at postoperative 1th day;the level of Blood glucose,NLR,PLR,WBC belong to decreased to preoperative level(P > 0.05)at postoperative 5th day,while WBC of OH group decreased to preoperative level at postoperative 5th day.The levels of C3,C4 and L were significantly lower than those before operation and reach to the lowest at postoperative 1th day(P <0.05),and immune indexes of the LH group was significantly higher than that of the OH group(P> 0.05)in addition to L at postoperative 1th?3th day and C4 at postoperative 1th day.at postoperative 3th day,the level of C3 and C4 in LH group was restored to the preoperative level,while the level of C3 and C4 in OH group increased to the preoperative level at postoperative 5th day.According to degree of stress inflammation and immune suppression,the patients were divided into two groups.The results of univariate analysis showed that open hepatectomy,long operation time,hepatic portal occlusion associated with heavy stress response and open hepatectomy,hepatic portal occlusion,the scope of excision associated with heavy immunosuppression.Multivariate analysis showed that open surgery was an independent risk factor for postoperative stress response and immunosuppression.ConclusionStress reaction and immunosuppression brought about by laparoscopic hepatectomy lighter than open hepatectomy;Laparotomy was an independent risk factor for stress response and immunosuppression after hepatectomy and the scope of excision was an independent risk factor for immunosuppression after hepatectomy.