Sido Bernd, Teklote Jörg-Rudolf, Hartel Mark, Friess Helmut, Büchler Markus W
Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
Best Pract Res Clin Anaesthesiol. 2004 Sep;18(3):439-54. doi: 10.1016/j.bpa.2003.12.006.
Surgical manipulation of the gut elicits an inflammatory cascade within the intestinal muscularis that contributes to postoperative bowel dysmotility. A range of cytokines is sequentially released into the peritoneal fluid following abdominal surgery, their concentrations reflecting the magnitude of surgical trauma. The overproduction of inflammatory mediators might have detrimental effects on organ function and contribute to the enhanced risk of anastomotic leakage in the presence of sepsis. Specific cellular immune functions such as the microbicidal activity of peritoneal phagocytes are depressed after elective surgery, imposing a risk of infectious complications. Laparoscopic surgery decreases the local and systemic production of cytokines and acute-phase reactants, and better preserves peritoneal immunity compared with open surgery. As concluded from animal studies, the gas used for the pneumoperitoneum may possess substantial immunomodulatory activity.
肠道的外科手术操作会引发肠肌层内的炎症级联反应，这会导致术后肠道运动障碍。腹部手术后，一系列细胞因子会依次释放到腹膜液中，其浓度反映了手术创伤的程度。炎症介质的过度产生可能会对器官功能产生不利影响，并在存在脓毒症的情况下增加吻合口漏的风险。选择性手术后，诸如腹膜吞噬细胞的杀菌活性等特定细胞免疫功能会受到抑制，从而带来感染性并发症的风险。与开放手术相比，腹腔镜手术可减少细胞因子和急性期反应物的局部及全身产生，并能更好地保留腹膜免疫功能。从动物研究得出的结论是，用于气腹的气体可能具有显著的免疫调节活性。
