Schwab R, Eissele S, Brückner U B, Gebhard F, Becker H P
Department of General Surgery, German Armed Forces Central Military Hospital, Rübenacher Str. 170, 56072, Koblenz, Germany.
Hernia. 2004 Aug;8(3):226-32. doi: 10.1007/s10029-004-0216-7. Epub 2004 Mar 20.
Endoscopic techniques are commonly used for many different types of surgery. It is claimed that videoendoscopic procedures have the advantage of being less traumatic and of offering higher postoperative patient comfort than conventional open techniques. The extent of tissue trauma can be evaluated on the basis of the inflammatory response observed in the wake of surgery. Available studies that have compared endoscopic and conventional techniques suggest that endoscopic cholecystectomy, laparoscopic colorectal resection, and thoracoscopic pulmonary resection have immunologic advantages over conventional approaches. The objective of this prospective study was to determine whether endoscopic hernia repair techniques are also preferable to conventional procedures and to what extent the anesthetic technique (local or general anesthesia) influences the postoperative inflammatory response. For this purpose, biochemical monitoring of cytokine activity [C-reactive protein (CRP), prostaglandin F1alpha (PGF1alpha), neopterin, interleukin-6 (IL-6)] was done prospectively in 101 patients [totally extraperitoneal approach (TEP) n=32, unilateral n=12, bilateral n=20; Shouldice n=69, local anesthesia (LA) n=23, general anesthesia (GA) n=46] before and until 3 days after surgery. The parameters IL-6 and PGF1alpha suggested that the immune trauma immediately after surgery was significantly higher in the group of patients with endoscopic hernia repair than in the group of patients who received a Shouldice repair. No significant differences were observed after the first postoperative day. A comparison between the TEP group and the patients who received conventional surgery under local anesthesia showed that the TEP approach was also associated with a higher postoperative neopterin level. Within the first 3 days after surgical intervention, bilateral endoscopic hernia repair induced no significantly higher inflammatory response than the surgical treatment of unilateral conditions. The anesthetic procedure that was used in the Shouldice operation had no significant effect on inflammatory response. Unlike other types of endoscopic surgery, the repair of groin hernias using an endoscopic technique cannot be regarded as a minimally invasive procedure that is less traumatic than conventional approaches. Instead, the conventional Shouldice procedure appears to cause the lowest inflammatory response and to be the least traumatic approach to hernia repair, especially when it is performed under local anesthesia.
内镜技术常用于多种不同类型的手术。据称，视频内镜手术比传统开放手术具有创伤小、术后患者舒适度高的优点。组织创伤程度可根据术后观察到的炎症反应来评估。比较内镜技术和传统技术的现有研究表明，内镜胆囊切除术、腹腔镜结直肠切除术和胸腔镜肺切除术比传统方法具有免疫学优势。这项前瞻性研究的目的是确定内镜疝修补技术是否也优于传统手术，以及麻醉技术（局部或全身麻醉）在多大程度上影响术后炎症反应。为此，对101例患者[完全腹膜外入路（TEP）n = 32，单侧n = 12，双侧n = 20；Shouldice法n = 69，局部麻醉（LA）n = 23，全身麻醉（GA）n = 46]在手术前及术后3天内进行了细胞因子活性[C反应蛋白（CRP）、前列腺素F1α（PGF1α）、蝶呤、白细胞介素-6（IL-6）]的生化监测。IL-6和PGF1α参数表明，内镜疝修补患者组术后即刻的免疫创伤明显高于接受Shouldice修补的患者组。术后第一天后未观察到显著差异。TEP组与局部麻醉下接受传统手术的患者之间的比较表明，TEP入路术后的蝶呤水平也较高。在手术干预后的前3天内，双侧内镜疝修补引起的炎症反应不比单侧疾病的手术治疗明显更高。Shouldice手术中使用的麻醉程序对炎症反应没有显著影响。与其他类型的内镜手术不同，使用内镜技术修复腹股沟疝不能被视为比传统方法创伤更小的微创手术。相反，传统的Shouldice手术似乎引起的炎症反应最低，是疝修补术中创伤最小的方法，尤其是在局部麻醉下进行时。
