Abstract
Objective To investigate the effect of cholecystectomy at different operation opportunity on stress reaction,immune function,and prognosis of patients with acute cholecystitis,so as to provide a clinical basis for the choice of the operation opportunity of acute cholecystitis.Methods 109 patients with acute cholecystitis were collected and were divided into early group (n=64) and delayed group (n=45) according to the time interval from onset to operation.All patients were treated with laparoscopic cholecystectomy.The early group underwent operation within 48 hours after onset,the delayed group underwent operation from 48 to 72 hours after onset.The serum superoxide dismutase (SOD),malondialdehyde (MDA),CD3+,and CD4+ levels at admission (T1),one hour before operation (T2),on the 1st day after operation (T3),on the 3rd day after operation (T4) between the two group were compared.At the same time,the incidences of postoperative complications (including edema,suppuration,gangrene,perforation,death) were recorded.Results The SOD,MDA levels in the early group at T1,T2,T3,T4 were respectively (78.9±10.2)U/ml,(78.9±10.2)U/ml,(110.2±6.5)U/ml,(56.0±5.1)U/ml,(6.5±0.9)mmol/L,(6.5±0.9)mmol/L,(8.6±l.3)mmol/L,(5.2±0.8)mmol/L,those in the delayed group were respectively (78.5±9.9) U/ml,(92.7±ll.5)U/ml,(140.7±9.8)U/ml,(70.9±8.7)U/ml,(6.4±l.0)mmol/L,(7.3±1.2)mmol/L,(10.5±1.6) mmol/L,(5.9±l.1)mmol/L;the SOD,MDA levels at T2,T3 gradually increased,began to decrease at T4 in the delayed group (P＜0.05);the SOD,MDA levels at T3 were obviously higher than those at T1,T2,began to decrease at T4 in the early group (P＜0.05);the SOD,MDA levels in the early group at T2,T3,T4 were obviously lower than those in the delayed group (P＜0.05).The CD3+,CD4+ levels in the early group at T1,T2,T3,T4 were respectively (56.1±9.4)％,(56.1±9.4)％,(46.5±7.2)％,(65.9±9.1)％,(32.6±8.4)％,(32.6±8.4)％,(29.7±7.2)％,(45.8±9.0)％,those in the delayed group were respectively (55.7±9.5)％,(50.7±8.8)％,(41.2±6.3)％,(52.2±8.5)％,(32.7±8.8)％,(29.1±8.0)％,(24.8±6.5)％,(36.2±5.1)％;the CD3+,CD4+ levels at T2,T3 gradually decreased,began to increase at T4 in the delayed group (P＜0.05);the CD3+,CD4+ levels at T3 were obviously lower than those at T1,T2,began to increase at T4 in the early group (P＜0.05);the CD3+,CD4+ levels in the early group at T2,T3,T4 were obviously higher than those in the delayed group (P＜0.05).The incidences of postoperative edema and suppuration in the early group were respectively 20.3％ and 54.7％,which were significantly higher than those in the delayed group (0％,13.3％) (P＜0.05),and the incidences of gangrene,perforation,and death were respectively 18.8％,4.7％,0％,which were significantly lower than those in the delayed group (57.8％,28.9％,6.7％) (P＜0.05).Conclusion For patients with acute cholecystitis,laparoscopic cholecystectomy should be performed as early as possible,the best operation time should be within 48 h,which can reduce the too strong stress reaction of the body and immune function damage,thereby reduce the risk of postoperative serious complications.关键词
手术时机/胆囊切除术/急性胆囊炎/应激反应/免疫功能Key words
Operative opportunity/Cholecystectomy/Acute cholecystitis/Stress reaction/Immune function
