METABOLIC AND INFLAMMATORY RESPONSES AFTER OPEN OR LAPAROSCOPIC CHOLECYSTECTOMY
METABOLIC AND INFLAMMATORY RESPONSES AFTER OPEN OR LAPAROSCOPIC CHOLECYSTECTOMY
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DOI：
10.1002/bjs.1800810146
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发表时间：
1994-01-01
影响因子：
9.6
通讯作者：
CARLI, F
中科院分区：
文献类型：
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作者：
JAKEWAYS, MSR;MITCHELL, V;CARLI, F
研究人员对接受腹腔镜（n = 14）或开腹（n = 10）选择性胆囊切除术的患者组进行了代谢和炎症反应以及疲劳变化的研究。腹腔镜和开腹胆囊切除术患者的平均皮质醇浓度(s.e.m.)显着(P < 0.001)从术前的342(80)和424(91)nmol·l(-1)增加到术后的895(46)和966(53)nmol·l(-1)。各组之间的皮质醇反应没有差异。腹腔镜手术和开腹手术手术结束时血糖浓度分别从术前平均(s.e.m) 5.54(0.15)和6.16(0.15) mmol l(-1)升高至术后7.46(0.29)和8.46(0.86) mmol l(-1)(P < 0.02)。开腹胆囊切除术术后最初 12 小时内的平均葡萄糖浓度显着高于腹腔镜胆囊切除术（P < 0.02）。手术期间平均（s.e.m.）白蛋白浓度显着下降（P < 0.01），下降幅度相当，从38.9（0.77）和38.5（1.10）g l（-1）降至35.2（0.79）和34.6（0.97）g l（-1）。平均（95％置信区间）白细胞介素（IL）6浓度在术后4小时达到峰值，腹腔镜手术后为57.2（44.6-73.4）pg ml（-1），开腹胆囊切除术后为99.3（72.8-135.4）pg ml（-1）。腹腔镜和开腹术后 24 小时的平均 C 反应蛋白 (CRP) 水平（95% 置信区间）为 17.0 (12.7-21.2) 和 49.0 (25.3-93.6) mg l(-1)，48 小时为 28.0 (21.4-35.4) 和 70.0 (36.4-133.6) mg l(-1)操作。各组间IL-6、CRP水平差异有统计学意义（P < 0.01）。腹腔镜和开腹手术后24小时，平均（s.e.m.）疲劳评分显着（P < 0.05）从术前的2.4（0.24）和2.6（0.44）增加到5.5（0.56）和6.8（0.51）。 48 小时时，仅在开腹胆囊切除术后，平均（s.e.m.）疲劳评分（5.6（0.57））仍显着升高（P < 0.05）。仅在开放手术后，手握力才显着降低（P < 0.05），平均值（s.e.m.）为术前值的 88（6）％。这些结果表明，腹腔镜胆囊切除术后代谢和急性期反应的各个方面都得到减弱，这与组织创伤的减少一致。
Metabolic and inflammatory responses and changes in fatigue were studied in groups of patients undergoing either laparoscopic (n = 14) or open (n = 10) elective cholecystectomy. The mean(s.e.m.) cortisol concentration was significantly (P < 0.001) increased from 342(80) and 424(91)nmol l(-1) before operation to 895(46) and 966(53) nmol l(-1) after surgery in patients undergoing laparoscopic and open cholecystectomy respectively. There was no difference in cortisol response between the groups. Glucose concentration was increased (P < 0.02) at the end of surgery from mean(s.e.m.) preoperative levels of 5.54(0.15) and 6.16(0.15) mmol l(-1) to postoperative values of 7.46(0.29) and 8.46(0.86) mmol l(-1) for the laparoscopic and open procedures respectively. The mean glucose concentration during the initial 12 h after surgery was significantly greater (P < 0.02) following open than laparoscopic cholecystectomy. The mean(s.e.m.) albumin concentration fell significantly (P < 0.01) during surgery by an equivalent extent from 38.9(0.77) and 38.5(1.10) g l(-1) to 35.2(0.79) and 34.6(0.97) g l(-1). The mean (95 per cent confidence interval) interleukin (IL)6 concentration peaked 4h after surgery at 57.2 (44.6-73.4) pg ml(-1) following laparoscopic and 99.3 (72.8-135.4) pg ml(-1) after open cholecystectomy. Mean (95 per cent confidence interval) C-reactive protein (CRP) levels at 24 h were 17.0 (12.7-21.2) and 49.0 (25.3-93.6) mg l(-1) and at 48 h 28.0 (21.4-35.4) and 70.0 (36.4-133.6) mg l(-1) following laparoscopic and open operations. The differences in IL-6 and CRP level between the groups were significant (P < 0.01). Mean(s.e.m.) fatigue scores were significantly (P < 0.05) increased from preoperative values of 2.4(0.24) and 2.6(0.44) to 5.5(0.56) and 6.8(0.51) at 24 h after laparoscopic and open operations. At 48 h the mean(s.e.m.) fatigue score (5.6(0.57)) remained significantly (P < 0.05) raised only after open cholecystectomy. Hand grip strength was significantly (P < 0.05) reduced only after the open procedure, to a mean(s.e.m.) of 88(6) per cent of the preoperative value. These results demonstrate that aspects of the metabolic and acute-phase responses are attenuated following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.