Zimmer S, Heiss M M, Schardey H M, Weilbach C, Faist E, Lauterjung L
Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, LMU Münhen.
Langenbecks Arch Chir Suppl Kongressbd. 1998;115(Suppl I):13-7.
Immunological changes as described in endovascular aortic aneurysm repair are not yet fully understood. In several studies this reaction (leukocytosis, fever, high CRP levels) is named as a "postimplantation syndrome". In our study we could show that in the first week after endovascular aortic aneurysm surgery complex immunological changes occur. But these changes do not quantitatively differ from those seen in open aortic aneurysm surgery. Fever (38 degrees C) was apparent in almost all patients. White blood cell count rose up to 10.6 (+/- 0.84) G/L during the first days. CRP, one of the acute phase proteins, was elevated with the maximum on postoperative day 2. Only the open operated patients had elevated alpha 1-antitrypsin levels from the second postoperative day on. IL-6 synthesis was increased in both groups, with an elevation in group B until day 8. The coagulation system was impaired, but was most evident in the open aortic aneurysm group. In this study we could show that both operative techniques had comparable immunological changes. During open aneurysm repair the large operative trauma seems to play a central role, whereas endothel activation might be crucial in endovascular operated patients.
血管腔内主动脉瘤修复术中所描述的免疫变化尚未完全明了。在多项研究中，这种反应（白细胞增多、发热、高CRP水平）被称为“植入后综合征”。在我们的研究中，我们能够证明在血管腔内主动脉瘤手术后的第一周会发生复杂的免疫变化。但这些变化在数量上与开放性主动脉瘤手术中所见的变化并无差异。几乎所有患者都出现发热（38摄氏度）。在最初几天白细胞计数升至10.6（±0.84）G/L。CRP作为急性期蛋白之一，术后第2天达到最高值。只有接受开放性手术的患者从术后第二天起α1-抗胰蛋白酶水平升高。两组IL-6合成均增加，B组至第8天升高。凝血系统受损，但在开放性主动脉瘤组最为明显。在本研究中，我们能够证明两种手术技术具有相似的免疫变化。在开放性动脉瘤修复术中，较大的手术创伤似乎起核心作用，而在内腔血管手术患者中内皮激活可能至关重要。
