Sitter H, Lorenz W, Klotter H J, Duda D, Buess G, Sattler J
Institute of Theoretical Surgery, University of Marburg, FRG.
Agents Actions. 1991 May;33(1-2):203-7. doi: 10.1007/BF01993168.
High technology plays an important role in surgery, either to expand surgical procedures or to reduce tissue trauma, which is a main goal of minimum invasive surgery. Due to the tremendous increase of costs the problem of technology assessment will not only be solved by statistical methods, but also by biomedical considerations and laboratory tests. Histamine release could be an indication for tissue trauma, which is caused directly by tissue damage or indirectly by infection or hypoxia. Therefore histamine release was investigated during different phases of operation in two clinically very important and complex situations: resection of liver metastases of colorectal carcinoma and resection of the oesophagus because of an oesophageal carcinoma. To model this situation in animal experiments, two randomized controlled studies were conducted in sheep. Traditional techniques were compared with techniques of minimum invasive surgery. Plasma histamine levels were determined at well-defined phases of the operation. Histamine release was demonstrated at distinct phases of operation indicating considerable specificity of this parameter, if sensitivity is guaranteed by advanced tests. Incision of the liver capsule by thermocauterization, liver ischaemia, tissue trauma in more extended disruption of perioesophageal tissue were causes of more extended histamine release. It is concluded that measurement of plasma histamine is a suitable indicator for discriminating between extended and minimum invasive surgery. The consequence of considering this parameter may be less complications in the post-operative period and a short hospital stay with better quality of life.
高科技在外科手术中发挥着重要作用，它既可以拓展手术操作，也能够减少组织创伤，而这正是微创手术的主要目标。由于成本的大幅增加，技术评估问题不仅要通过统计方法来解决，还需借助生物医学考量和实验室检测。组胺释放可能是组织创伤的一个指标，组织创伤可由组织损伤直接引起，也可由感染或缺氧间接导致。因此，在两种临床非常重要且复杂的情况下，即在结直肠癌肝转移切除术和食管癌食管切除术的不同手术阶段，对组胺释放情况进行了研究。为在动物实验中模拟这种情况，在绵羊身上进行了两项随机对照研究。将传统技术与微创手术技术进行了比较。在明确界定的手术阶段测定血浆组胺水平。在手术的不同阶段均证实有组胺释放，这表明如果先进检测能保证敏感性，该参数具有相当的特异性。通过热灼切开肝包膜、肝脏缺血以及食管周围组织更广泛破坏时的组织创伤，均会导致更广泛的组胺释放。得出的结论是，血浆组胺测量是区分广泛手术和微创手术的合适指标。考虑这一参数的结果可能是术后并发症减少、住院时间缩短且生活质量提高。
