General Stress Response to Conventional and Laparoscopic Cholecystectomy
General Stress Response to Conventional and Laparoscopic Cholecystectomy
复制标题
对传统和腹腔镜胆囊切除术的一般应激反应
作者：
R. Glaser;G. Sannwald;H. Buhr;C. Kuntz;H. Mayer;F. Klee;C. Herfarth
在许多回顾性和前瞻性观察性研究中，腹腔镜胆囊切除术（LC）在住院时间、术后疼痛和肺功能方面优于传统胆囊切除术（CC），表明手术创伤减少。实验室检查结果（应激激素、血糖、白细胞介素）的比较有可能客观化腹腔镜胆囊切除术和传统胆囊切除术的应激和组织创伤。主要的身体损伤，无论是手术还是意外，都能引起可重复的激素和免疫反应。许多这些变化的幅度基本上与损伤的程度成比例。方法采用前瞻性研究方法，测定因症状性胆囊结石行择期胆囊切除术患者的血液生化应激指标。排除急性胆囊炎、胰腺炎、胆总管结石或恶性疾病患者。比较了40例LC后患者和18例CC后患者的值。两组患者的特征、基线值和围手术期护理相似，但CC期间的深度麻醉除外。结果术后第1天，肾上腺素（p = 0.05）、去甲肾上腺素（p = 0.02）和葡萄糖（p = 0.02）反应在CC后较高。术后2天，CC后去甲肾上腺素仍较高（p < 0.01）。白细胞介素-1 β反应在CC期间（p < 0.01）和CC后6小时（p = 0.03）更高。CC后6小时（p = 0.03）、1天（p = 0.02）和2天（p < 0.01）的白细胞介素-6应答更高。结论腹腔镜胆囊切除术患者术中和术后肾上腺素、去甲肾上腺素、白细胞介素-1 β和白细胞介素-6水平明显降低，提示该组患者存在轻微的应激反应和组织损伤。该结果与大多数其他评价腹腔镜胆囊切除术临床方面的试验的有利结果一致。
ObjectiveIn many retrospective and prospective observational studies, laparoscopic cholecystectomy (LC) compares favorably with conventional cholecystectomy (CC), with respect to length of hospital stay, postoperative pain, and pulmonary function, indicating a diminished operative trauma. Comparison of laboratory findings (stress hormones, blood glucose, interleukins) are a possibility to objectify stress and tissue trauma of laparoscopic and conventional cholecystectomy. Summary Background DataMajor body injury, surgical or accidental, evokes reproducible hormonal and immunologic responses. The magnitude of many of these changes essentially is proportional to the extent of the injury. MethodsIn a prospective study, biochemical stress parameters were measured in the blood of patients undergoing elective cholecystectomy because of symptomatic cholecystolithiasis. Patients with acute cholecystitis, pancreatitis, choledocholithiasis, or malignant disease were excluded. Values from 40 patients after LC and from 18 patients after CC were compared. Both groups had similar patient characteristics, baseline values, and perioperative care, except for deeper anesthesia during CC. ResultsOn postoperative day 1, epinephrine (p = 0.05), norepinephrine (p = 0.02), and glucose (p = 0.02) responses were higher after CC. Two days postoperatively, norepinephrine remained higher after CC (p < 0.01). Interleukin-1β responses were higher during (p < 0.01) and 6 hours after CC (p = 0.03). Interleukin-6 responses were higher 6 hours (p = 0.03), 1 day (p = 0.02), and 2 days (p < 0.01) after CC. ConclusionsThe results show significant lower values of intraoperatively and postoperatively measured epinephrine, norepinephrine, interleukin-1β, and interleukin-6 in patients with laparoscopic cholecystectomy, indicating a minor stress response and tissue trauma in this group of patients. The results correspond to the favorable results of most other trials evaluating clinical aspects of laparoscopic cholecystectomy.