悬吊式无气腹与气腹腹腔镜手术对妇科病人应激反应的影响

Effects of Carbon Dioxide Pneumoperitoneum and Abdominal Wall-lift Method on the Stress Response in Patients Undergoing Gynecological Laparoscopic Operation

目的比较妇科无气腹悬吊式腹腔镜和气腹腹腔镜手术对病人应激反应影响的差异。方法采用前瞻性对照研究的方法,选择2005年7月～2006年2月择期行腹腔镜下卵巢肿瘤切除术38例,按患者意愿分成2组,每组19例。Ⅰ组于全麻下行CO2气腹腹腔镜手术;Ⅱ组于全麻下行悬吊式腹腔镜手术。监测2组患者麻醉前(T1)、气腹或悬吊建立后30min(T2)、气腹或悬吊撤除后10 min(T3)和术后次日晨8时(T4)4个时点的血糖、胰岛素、皮质醇、TNF-α和IL-6水平。结果麻醉前2组血糖、胰岛素、皮质醇、TNF-α和IL-6水平差异无显著性(P>0.05)。气腹或悬吊后上述各指标水平均升高(P<0.05)。其中胰岛素水平逐渐升高,至T4时最高。Ⅰ组的血糖、皮质醇、TNF-α和IL-6水平至T3时最高,Ⅱ组至T4时最高。组间比较,在T2时点,Ⅰ组的皮质醇和TNF-α水平高于Ⅱ组(P<0.05),在T3时点,Ⅰ组的血糖、皮质醇、TNF-α和IL-6水平均显著高于Ⅱ组(P<0.01)。结论无气腹悬吊式腹腔镜技术免除了CO2气腹对机体的影响,降低了术中应激反应水平。

Objective To compare the stress response in patients received gynecological laparoscopic operations with carbon dioxide pneumoperitoneum or abdominal wall-lift laparoscopic surgery . Methods Thirty-eight patients （ ASA Ⅰ - Ⅱ ） scheduled for gynecological laparoscopy from July 2005 to February 2006 were enrolled in this study. According to their own will, the patients were divided into groups Ⅰ and Ⅱ （ 19 cases in each）. Group Ⅰreceived CO2 insufflation, while group Ⅱ were treated by abdominal wall-lift technique. In both the groups, gynecological laparoscopic operation was performed under general anesthesia. The serum levels of blood glucose, insulin, cortisol, TNF-α, and IL-6 were measured in all the patients at four time points： before the anesthesia （T1） , 30 minutes after beginning the operations （T2 ） , 10 minutes after the surgery （T3 ） , and 8 AM in the following day （ T4 ）. Results Before the operation, no significant difference was found between the two groups in the levels of blood glucose, insulin, cortisol, TNF-α, and IL-6 （ P 〉 0. 05 ）. After being treated with carbon dioxide pneumoperitoneum or abdominal wall-lift method, the values increased significantly （P 〈 0.05） , among which, the level of insulin reached the peak at T4. In the group Ⅰ , the concentration of blood glucose, cortisol, TNF-α, and IL-6 reached the peak at T3 , while in the group Ⅱ , it was at T4. At T2 , the levels of cortisol and TNF-α in group I were significantly higher than those in the group Ⅱ （P 〈 0. 05） ; and at T3 , the serum concentrations of blood glucose, cortisol, TNF-α, and IL-6 of group Ⅰ were significantly higher than those of the group Ⅱ（P 〈 0.01 ）. Conclusion Gynecological laparoscopic operation using abdominal wall-lift methods can avoid the effect of CO2 pneumoperitoneum, reducing the stress response in the patients.