机体对三种胆囊切除手术应激反应观察

Influence of Three Cholecystectomies on Stress Response

目的探讨腹腔镜胆囊切除术的临床应用价值。方法将90例择期行胆囊切除术的患者随机分为3组,即传统组、小切口组和腹腔镜组,每组各30例。观察3组患者术前24 h(T1)、术后24 h(T2)、术后48 h(T3)的应激激素:血清皮质醇、血清促肾上腺皮质激、血清去甲肾上腺素的变化,以及细胞因子:肿瘤坏死因子、白细胞介素-6、白细胞介素-1的变化。结果 3组T1时间点各应激激素及细胞因子水平差异无统计学意义(P>0.05);T2、T3时间点与T1时间点相比各应激激素及细胞因子水平明显增高,差异有统计学意义(P<0.05或P<0.01);腹腔镜组在T2、T3时间点各应激激素及细胞因子水平明显低于传统组和小切口组,其差异有统计学意义(P<0.05或P<0.01)。结论腹腔镜胆囊切除术因其可以明显减轻手术创伤引起的应激反应,故值得临床推广应用。

Objective To investigate the clinical application value of laparoscopic cholecystectomy. Methods 90 patients undergoing cholecystectomy were randomly divided into 3 groups,with 30 patients in each group,including the traditional group（ I group）,small incision group（ Ⅱ group） and laparoscopic group（ Ⅲ group）. Change of stress- hormones： serumcortisol（ COR）,serum adrenocorticotropic shock（ ACTH）,serum norepinephrine（ NE）; cytokines： tumor necrosis factor alpha（ TNF- α）,interleukin- 6（ IL- 6） interleukin- 1（ IL-1） in the3 groups were observed before operation for 24 hours（ T1）,24 hours after operation（ T2）,48 hours after operation（ T3）.Results There was no statistically significant difference among the three groups in T1 time point of the stress hormone and cytokine levels（ P〉0.05）; the stress hormone and cytokine levels of T2,T3 time and T1 time point were significantly higher,with statistically significant difference（ P〈0. 05 or P〈 0. 01）; in group III,hormone and cytokine levels of T2,T3 time were significantly lower than group I and group II,and the difference was statistically significant（ P〈 0. 05 or P〈 0. 01）. Conclusion Laparoscopic cholecystectomy for stress response can significantly reduce the operation trauma,so it is worthy of clinical application.