Laparoscopy vs minilaparotomy and full laparotomy preserves circulatory but not peritoneal and pulmonary immune responses
Laparoscopy vs minilaparotomy and full laparotomy preserves circulatory but not peritoneal and pulmonary immune responses
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DOI：
10.1016/j.jpedsurg.2006.02.002
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发表时间：
2006-06-01
影响因子：
2.4
通讯作者：
Ure, Benno M.
中科院分区：
文献类型：
--
作者：
Jesch, Natalie K.;Kuebler, Jochen F.;Ure, Benno M.
目的：腹腔镜检查与较低的炎症反应有关。然而，它已被假定，minilaparotomy，在对比完整的剖腹手术，是同样微创。目的：本研究的目的是调查局部，全身和远处器官免疫反应后，不同的手术方法，腹腔，如minilaparotomy，完整的剖腹手术，腹腔镜，在一个小动物模型。方法：雄性刘易斯大鼠接受永久性中心静脉导管，并随机分为4组（每组n = 6）。对动物进行单独麻醉（对照）、小切口剖腹术（1 cm）、完全剖腹术（7 cm）或腹腔镜检查60分钟。在干预开始前以及干预开始后1小时和6小时通过中心静脉导管采集血液。腹膜和支气管肺泡灌洗，以及心脏穿刺，进行后24 hours.Results：所有的手术干预导致一个显着的多形核细胞迁移到腹腔。与对照组相比，完全剖腹手术导致腹腔巨噬细胞产生的一氧化氮显著增加。腹腔镜手术和小切口手术后巨噬细胞一氧化氮的产生没有显著差异。OX-6和CD 54表达的变化仅在完全剖腹手术后检测到。从全身来看，循环单核细胞释放的O-2（-）在小切口和全开腹手术后显著增加，但在腹腔镜手术后没有增加。全身IL 6水平仅在完全剖腹手术后显著加速，在6小时后达到最大值。在肺，肺泡巨噬细胞的功能没有改变，在任何group.Conclusions：任何方法的腹腔引起局部炎症反应。完全剖腹术比小切口剖腹术或腹腔镜手术更明显地改变腹腔巨噬细胞的功能。小型剖腹手术和全剖腹手术都会显着增加全身炎症反应，例如自由氧自由基释放，而腹腔镜手术则可以保留全身免疫功能。我们的研究结果可能会导致进一步偏好腹腔镜手术的方法，而不是小切口剖腹手术和全剖腹手术。(c)2006年爱思唯尔公司All rights reserved.
Purpose: Laparoscopy has been associated with lower inflammatory responses. However, it has been postulated that minilaparotomy, in contrast to full laparotomy, is equally minimally invasive.Objective: The aim of this study was to investigate local, systemic, and distant organ immune responses after different surgical approaches to the abdominal cavity, such as minilaparotomy, full laparotomy, and laparoscopy, in a small animal model.Methods: Male Lewis rats received a permanent central venous catheter and were randomized to 4 groups (n = 6 per group). The animals were subjected to anesthesia alone (control), minilaparotomy (1 cm), full laparotomy (7 cm), or laparoscopy for 60 minutes. Blood was collected via the central venous catheter before as well as 1 hour and 6 hours after the start of intervention. Peritoneal and bronchoalveolar lavages, as well as heart puncture, were performed after 24 hours.Results: All surgical interventions led to a significant migration of polymorphonucleocytes into the abdominal cavity. Full laparotomy resulted in a significant increase in nitric oxide production by peritoneal macrophages as compared with control. Macrophage nitric oxide production after laparoscopy and minilaparotomy was not significantly different. A shift in the expression of OX-6 and CD54 was only detected after full laparotomy. Systemically, O-2(-) release by circulating mononuclear cells was significantly increased after minilaparotomy and full laparotomy, but not after laparoscopy. The systemic levels of IL6 were significantly accelerated only after full laparotomy, with a maximum after 6 hours. In the lungs, function of alveolar macrophages was not altered in any group.Conclusions: Any approach to the peritoneal cavity causes local inflammatory responses. Full laparotomy alters peritoneal macrophage functions more pronouncedly than does minilaparotomy or laparoscopy. Systemic inflammatory responses, such as free oxygen radical release, are significantly increased by both minilaparotomy and full laparotomy, whereas laparoscopy preserves systemic immune function. Our results may lead to further preference for the laparoscopic approach over minilaparotomy and full laparotomy. (c) 2006 Elsevier Inc. All rights reserved.