Grande M, Tucci G F, Adorisio O, Barini A, Rulli F, Neri A, Franchi F, Farinon A M
Department of Surgery, University of Rome Tor Vergata, via di Tor Vergata 135, 00131 Rome, Italy.
Surg Endosc. 2002 Feb;16(2):313-6. doi: 10.1007/s00464-001-9042-5. Epub 2001 Nov 12.
Cytokines are the main mediators of inflammation and the response to trauma. The purpose of this study was to compare variations in cytokine levels following laparoscopic cholecystectomy (LC) and mini-laparotomy cholecystectomy (OC), since these two types of operations were considered to be a unique model for examining the role of local tissue injury in postoperative inflammatory reactions.
A total of 40 patients were studied. Eighteen of them underwent LC; the remaining 22 were operated on using the open technique. Systemic concentrations of interleukin-6 (IL-6), interleukin-1 (IL-1), tumor necrosis factor (TNF), and C-reactive protein (CRP) were measured before and after the operation. In addition, we compared pre- and postoperative white blood cell (WBC) counts, postoperative body temperature, and length of postoperative hospitalization.
There was no difference between the two groups in IL-1 and TNF response. The rise in plasma IL-6 levels (18.86 +/- 9.61 vs 5.00 +/- 0.0 pg/ml, p < 0.0001) and CRP (8.40 +/- 5.81 vs 1.43 +/- 1.30 mg/dl, p < 0.001) were more marked after open cholecystectomy than after the laparoscopic procedure. There was no correlation between serum CRP concentrations and the other postoperative parameters.
The magnitude of the acute-phase response was less pronounced following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.
细胞因子是炎症和创伤反应的主要介质。本研究的目的是比较腹腔镜胆囊切除术（LC）和小切口开腹胆囊切除术（OC）后细胞因子水平的变化，因为这两种手术被认为是研究局部组织损伤在术后炎症反应中作用的独特模型。
共研究了40例患者。其中18例行LC；其余22例行开放手术。在手术前后测量白细胞介素-6（IL-6）、白细胞介素-1（IL-1）、肿瘤坏死因子（TNF）和C反应蛋白（CRP）的全身浓度。此外，我们比较了术前和术后白细胞（WBC）计数、术后体温和术后住院时间。
两组在IL-1和TNF反应方面无差异。开腹胆囊切除术后血浆IL-6水平（18.86±9.61对5.00±0.0 pg/ml，p<0.0001）和CRP（8.40±5.81对1.43±1.30 mg/dl，p<0.001）的升高比腹腔镜手术后更明显。血清CRP浓度与其他术后参数之间无相关性。
腹腔镜胆囊切除术后急性期反应的程度较轻，这与组织创伤的减轻一致。
