Department of Surgery, University Hospital Basel, Basel, Switzerland.
Eur Cytokine Netw. 2010 Mar;21(1):50-7. doi: 10.1684/ecn.2009.0180.
Open, right-sided, transthoracic esophagectomy with one-lung ventilation (OLV) triggers a massive inflammatory reaction. The influence of the OLV on the inflammatory cascade is unclear. Data on the inflammatory response in the ventilated left and collapsed right lung, respectively, are scarce. The aim of this study was to analyze this reaction in bronchoalveolar lavage (BAL) fluid from both lungs, the right pleural space and the peripheral blood, and to study its time course.
Concentrations of interleukin (IL)-6, IL-8, IL-10 and IL-1RA in the BAL fluids from the right and left lungs, respectively, in the peripheral blood and in the right pleural space in patients undergoing transthoracic esophagectomy for cancer, were determined using enzyme-linked immunosorbent assays in 29 patients.
Assay of the pro-inflammatory cytokines in the bilateral BAL fluids showed significantly higher concentrations in the ventilated left lung at the time of extubation. The anti-inflammatory response was only seen with respect to IL-1RA, but not IL-10, and was mostly restricted to the ventilated left lung. In the blood, only IL-6, IL-10 and IL-1RA increased, whereas IL-8 showed little change. The response was already observed at the end of surgery, indicating a rapid reaction to the surgical and anesthetic trauma. In the pleural fluid, all cytokine concentrations increased, and the highest values were detected on day one post-surgery, and decreased thereafter. Pulmonary complications or anastomotic leakage were not related to the cytokine concentrations.
Both the ventilated left and the collapsed right lung showed an inflammatory response. The response was more pronounced on the ventilated left side and the time courses were significantly different. In the blood, the pro-inflammatory IL-6 and both anti-inflammatory cytokines increased early on. All cytokines increased in the pleural cavity. The findings underline the complexity of the inflammatory reaction associated with OLV in transthoracic esophagectomy.
经胸开放性右侧剖胸食管切除术联合单肺通气（OLV）会引发剧烈的炎症反应。OLV 对炎症级联的影响尚不清楚。关于通气左肺和塌陷右肺的炎症反应的数据很少。本研究旨在分析来自双侧支气管肺泡灌洗液（BAL）、右侧胸腔和外周血的炎症反应，并研究其时间过程。
对 29 例接受经胸食管癌切除术的患者，采用酶联免疫吸附试验测定右肺和左肺 BAL 液、外周血和右侧胸腔中白细胞介素（IL）-6、IL-8、IL-10 和 IL-1RA 的浓度。
双侧 BAL 液中促炎细胞因子的测定结果显示，拔管时通气左肺的浓度明显更高。抗炎反应仅见于 IL-1RA，但不包括 IL-10，并且主要局限于通气左肺。在血液中，只有 IL-6、IL-10 和 IL-1RA 增加，而 IL-8 变化不大。该反应在手术结束时就已经观察到，表明手术和麻醉创伤会迅速引发反应。在胸腔液中，所有细胞因子浓度均增加，术后第 1 天检测到最高值，此后逐渐降低。肺部并发症或吻合口漏与细胞因子浓度无关。
通气的左肺和塌陷的右肺均表现出炎症反应。左侧通气侧的反应更为明显，且时间过程明显不同。在血液中，促炎的 IL-6 和两种抗炎细胞因子早期增加。所有细胞因子在胸腔中均增加。这些发现强调了与经胸开放性右侧剖胸食管切除术联合单肺通气相关的炎症反应的复杂性。
