The influence of CO2 vs helium insufflation or the abdominal wall lifting technique on the systemic immune response
The influence of CO2 vs helium insufflation or the abdominal wall lifting technique on the systemic immune response
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DOI：
10.1007/s00464-001-0063-x
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发表时间：
2002-03-01
影响因子：
3.1
通讯作者：
Cuesta, MA
中科院分区：
文献类型：
--
作者：
Sietses, C;von Blomberg, ME;Cuesta, MA
背景：腹腔镜术和传统手术都能激活全身免疫反应：然而，使用CO2气腹的腹腔镜术的影响要小得多。关于不同的腹腔镜术方法，如氦气充气和腹壁提升技术(AWLT)以及全身免疫反应的影响，人们知之甚少。方法：33例择期行胆囊切除术的患者随机分为两组，分别接受CO2或氦气腹壁充气的腹腔镜术和仅采用腹壁提升技术的腹腔镜术。通过检测白细胞计数、C-反应蛋白(CRP)和白细胞介素6(IL-6)来评价术后炎症反应。结果：氦气隔离后第1天，C反应蛋白水平明显高于二氧化碳充气后，但术后第2天无明显差异。与CO2或氦气腹相比，AWLT组术后1天和2天的CRP水平显著升高。术后各组IL-6水平均有小幅升高，但组间差异无统计学意义。在氦气隔离和AWLT后，与CO组相比，HLADR的表达显著降低。结论：二氧化碳用于腹部气腹似乎限制了术后的炎症反应，并保留了反映免疫状态的参数。这些发现可能对确定肿瘤手术中首选的腹腔镜手术方法有重要意义。
Background: Both laparoscopic and conventional surgery result in activation of the systemic immune response: however, the influence of the laparoscopic approach, using CO2 insufflation, is significantly less. Little is known about the influence of alternative methods for performing laparoscopy, such as helium insufflation and the abdominal wall lifting technique (AWLT), and the systemic immune response.Methods: Thirty-three patients scheduled for elective cholecystectomy were randomly assigned to undergo laparoscopy using either CO2 or helium for abdominal insufflation or laparoscopy using only the AWLT. The postoperative inflammatory response was assessed by measuring the white blood cell count, C-reactive protein (CRP) and interleukin-6 (IL-6). The postoperative immune response was assessed by measuring monocyte HLA-DR expression.Results: CRP levels were significantly higher 1 day, after helium insulation when compared with CO2 insufflation; however, no differences were observed 2 days after surgery. The AWLT resulted in significantly higher levels of CRP both 1 and 2 days after surgery when compared with either CO2 or helium insufflation. A small increase in postoperative IL-6 levels was observed in all groups, but no significant differences were seen between the groups. After both helium insulation and AWLT a significant decrease in HLA-DR expression was observed, in contrast to the CO, group.Conclusion: Carbon dioxide used for abdominal insufflation seems to limit the postoperative inflammatory response and to preserve parameters reflecting the immune status. These findings may be of importance in determining the preferred method of laparoscopy in oncologic surgery.