Mansour M A, Stiegmann G V, Yamamoto M, Berguer R
Department of Surgery, University of Colorado Health Sciences Center, Denver.
Surg Endosc. 1992 Nov-Dec;6(6):294-7. doi: 10.1007/BF02498863.
Minimally invasive operations such as laparoscopic cholecystectomy appear to result in more rapid recovery of normal function, less physiological disturbance, and presumably less stress to the organism than open operation counterparts. The purpose of this study was to determine the stress response associated with minimally invasive surgery compared to conventional laparotomy. Three groups of pigs underwent general endotracheal anesthesia. The first group had laparoscopic cholecystectomy, the second open cholecystectomy, and the last group (controls) had only general anesthesia. The neuroendocrine serum stress markers adrenocorticotropic hormone (ACTH), cortisol, insulin, and glucagon were measured prior to anesthesia and for the first 3 postoperative days. Analysis of the data showed significant elevations of both ACTH and cortisol for laparoscopic operations as well as for open operation (cortisol only) in the immediate postoperative period. No differences were found for the other serum stress markers. We conclude that minimally invasive surgery in this porcine model confers no advantage, as measured by four neuroendocrine stress hormones, over conventional surgery. Further study is required to determine the clinical implication of these findings.
诸如腹腔镜胆囊切除术等微创手术似乎比开放式手术能使正常功能恢复得更快，对生理的干扰更小，对机体造成的应激可能也更小。本研究的目的是确定与传统剖腹手术相比，微创手术所引发的应激反应。三组猪接受了全身气管内麻醉。第一组进行腹腔镜胆囊切除术，第二组进行开放式胆囊切除术，最后一组（对照组）仅接受全身麻醉。在麻醉前以及术后的头3天测量神经内分泌血清应激标志物促肾上腺皮质激素（ACTH）、皮质醇、胰岛素和胰高血糖素。数据分析显示，腹腔镜手术以及开放式手术（仅皮质醇）在术后即刻，ACTH和皮质醇均显著升高。其他血清应激标志物未发现差异。我们得出结论，在这个猪模型中，通过四种神经内分泌应激激素衡量，微创手术相对于传统手术并无优势。需要进一步研究以确定这些发现的临床意义。
