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目的探讨腹腔镜下幽门环肌切开术围手术期CO2气腹对患儿细胞免疫的影响及临床意义。方法选择40例先天性肥厚性幽门狭窄患儿,随机分为腹腔镜组和开腹组,分别于术前及术后1d、3d监测围手术期CD3、CD4、CD4/CD8的变化。结果开腹组CD4术后1d轻微下降,术后3d明显升高,术后1d与3d比较,差异有显著统计学意义(P=0.007);开腹组CD4/CD8术后1d下降,与术前比较,差异有统计学意义(P=0.044);术后3d升高,与术后1d比较,差异有显著统计学意义(P=0.003)。腹腔镜组CD3术后1d下降,与术前比较,差异有显著统计学意义(P=0.023),术后3d明显升高,与术前比较,差异无统计学意义(P=0.596);两组比较CD4/CD8腹腔镜组较高,差异有显著性(F=3.961,P<0.05)结论新生儿及婴儿腹腔镜手术可引起机体免疫功能的改变,腹腔镜组对机体免疫功能的影响较小。
Objective To investigate the effect of perioperative CO2 pneumoperitoneum on cellular immunity in children undergoing laparoscopic pyloromyotomy and its clinical significance. Methods Forty patients with congenital hypertrophic pyloric stenosis were randomly divided into laparoscopic group and laparotomy group. The changes of perioperative CD3, CD4 and CD4 / CD8 levels were monitored before and 1 day and 3 days after operation respectively. Results The CD4 in the open group decreased slightly 1 d after operation and significantly increased 3 days after operation. The difference was statistically significant at 1 day and 3 days after operation (P = 0.007) The difference was statistically significant (P = 0.044). After 3 days, the difference was statistically significant (P = 0.003). In laparoscopic group, the level of CD3 decreased at 1 day after operation, which was significantly different from that before operation (P = 0.023), significantly higher at 3 days after operation (P = 0.596). There was no significant difference between two groups The difference between the two groups was significant (F = 3.961, P <0.05). Conclusions Laparoscopic surgery in neonates and infants can cause the change of immune function. The effect of laparoscopy group on immune function small.