Jesch Natalie K, Kuebler Jochen F, Nguyen Hiep, Nave Heike, Bottlaender Michael, Teichmann Birgit, Braun Armin, Vieten Gertrud, Ure Benno M
Department of Pediatric Surgery, Hanover Medical School, 30625 Hanover, Germany.
J Pediatr Surg. 2006 Jun;41(6):1085-92. doi: 10.1016/j.jpedsurg.2006.02.002.
Laparoscopy has been associated with lower inflammatory responses. However, it has been postulated that minilaparotomy, in contrast to full laparotomy, is equally minimally invasive.
The aim of this study was to investigate local, systemic, and distant organ immune responses after different surgical approaches to the abdominal cavity, such as minilaparotomy, full laparotomy, and laparoscopy, in a small animal model.
Male Lewis rats received a permanent central venous catheter and were randomized to 4 groups (n = 6 per group). The animals were subjected to anesthesia alone (control), minilaparotomy (1 cm), full laparotomy (7 cm), or laparoscopy for 60 minutes. Blood was collected via the central venous catheter before as well as 1 hour and 6 hours after the start of intervention. Peritoneal and bronchoalveolar lavages, as well as heart puncture, were performed after 24 hours.
All surgical interventions led to a significant migration of polymorphonucleocytes into the abdominal cavity. Full laparotomy resulted in a significant increase in nitric oxide production by peritoneal macrophages as compared with control. Macrophage nitric oxide production after laparoscopy and minilaparotomy was not significantly different. A shift in the expression of OX-6 and CD54 was only detected after full laparotomy. Systemically, O(2)(-) release by circulating mononuclear cells was significantly increased after minilaparotomy and full laparotomy, but not after laparoscopy. The systemic levels of IL6 were significantly accelerated only after full laparotomy, with a maximum after 6 hours. In the lungs, function of alveolar macrophages was not altered in any group.
Any approach to the peritoneal cavity causes local inflammatory responses. Full laparotomy alters peritoneal macrophage functions more pronouncedly than does minilaparotomy or laparoscopy. Systemic inflammatory responses, such as free oxygen radical release, are significantly increased by both minilaparotomy and full laparotomy, whereas laparoscopy preserves systemic immune function. Our results may lead to further preference for the laparoscopic approach over minilaparotomy and full laparotomy.
腹腔镜手术与较低的炎症反应相关。然而，有人推测，与全腹手术相比，小切口剖腹术同样具有微创性。
本研究的目的是在小动物模型中，研究不同的腹腔手术入路（如小切口剖腹术、全腹手术和腹腔镜手术）后局部、全身和远处器官的免疫反应。
雄性Lewis大鼠植入永久性中心静脉导管，并随机分为4组（每组n = 6）。动物分别接受单纯麻醉（对照组）、小切口剖腹术（1厘米）、全腹手术（7厘米）或腹腔镜手术60分钟。在干预开始前以及开始后1小时和6小时，通过中心静脉导管采集血液。24小时后进行腹腔和支气管肺泡灌洗以及心脏穿刺。
所有手术干预均导致多形核白细胞大量迁移至腹腔。与对照组相比，全腹手术导致腹腔巨噬细胞产生的一氧化氮显著增加。腹腔镜手术和小切口剖腹术后巨噬细胞一氧化氮的产生无显著差异。仅在全腹手术后检测到OX-6和CD54表达的变化。在全身，小切口剖腹术和全腹手术后循环单核细胞释放的O(2)(-)显著增加，但腹腔镜手术后未增加。仅在全腹手术后，IL6的全身水平显著加速，6小时后达到峰值。在肺部，任何一组的肺泡巨噬细胞功能均未改变。
任何进入腹腔的方法都会引起局部炎症反应。与小切口剖腹术或腹腔镜手术相比，全腹手术对腹腔巨噬细胞功能的改变更为明显。小切口剖腹术和全腹手术均显著增加全身炎症反应，如自由基释放，而腹腔镜手术可保留全身免疫功能。我们的结果可能会导致进一步倾向于选择腹腔镜手术而非小切口剖腹术和全腹手术。
