腹腔镜途径与开放途径根治性膀胱切除对机体创伤的影响

Surgical stress response in open versus laparoscopic radical cystectomy

目的探讨腹腔镜根治性膀胱切除术与开放手术对机体损伤程度的差异。方法收集开放根治性膀胱切除术24例(开放组),手助腹腔镜和纯腹腔镜根治性膀胱切除术14例(腹腔镜组),测定并比较两组患者在手术麻醉后、术中以及术后第三天IL-6和IFN-γ的变化以及机体全身炎症反应综合征的发生情况。结果两组患者在年龄、性别、体重指数、尿流改道方式及肿瘤分期方面均无差别(P>0.05)。腹腔镜组术后8例出现全身炎症反应综合征,占57.1%,而开放组中19例出现全身炎症反应综合征,占79.2%,两组相比无统计学意义(P=0.149)。腹腔镜组全身炎症反应综合征的平均持续时间为1.4d,而开放组为2.8d,腹腔镜组明显少于开放组(P=0.032)。腹腔镜组和开放组术中IL-6的浓度均较术前升高,但无统计学意义(P>0.05),两组术后第三天的IL-6浓度均较术前、术中明显升高(P<0.05)。两组术前IL-6的浓度无明显差异(P=0.607),但开放组术中和术后IL-6的浓度均比腹腔镜组升高更明显(P<0.05)。两组术中和术后的IFN-γ浓度均较术前降低,但两组术前、术中和术后IFN-γ浓度相比都无明显差别(P>0.05)。结论腹腔镜根治性膀胱切除手术对机体的损伤较开放手术小,全身炎症反应综合征持续的时间明显短于开放手术。

Objective To compare the surgical stress response of laparoscopic radical cystectomy with that of open radical cystectomy by the incidence of systemic infammatory response syndrome (SIRS) and measurement of humoral mediators. Methods Patients who underwent open radical cystectomy(24 patients) and those who underwent laparoscopic radical cystectomy(14 patients) were enrolled in this study. Blood samples were obtained from all patients before surgery, during surgery, 72h after surgery. Serum levels of interleukin (IL)-6 and IFN-γ in these samples were measured using an enzyme-linked immunosorbent assay. We also investigated the incidence and duration of SIRS in the two groups. Results The incidence of SIRS was 57.1% (8 patients) in the laparoscopic group and 79.2% (19 patients) in the open group (P=0.149, Fisher’s exact probability test).The mean duration of SIRS was 1.4 days in the laparoscopic group and 2.8 days in the open group (P=0.032). The IL-6 levels were similar in both groups preoperatively, and IL-6 levels increased during surgery and after surgery in the two groups.However, the IL-6 levels in the laparoscopic surgery group were signi?cantly lower than those in the open surgery group during surgery and after surgery.The IFN-γ levels decreased during surgery and after surgery in the two groups, but there was no difference in the two groups preoperatively, during surgery and after surgery (P>0.05). Conclusions Our study suggests that laparoscopic radical cystectomy is markedly less stressful and it has a shorter duration of SIRS than open surgery.