Department of Anaesthesiology & Intensive Care, Sahlgrenska University Hospital/East, Göteborg, Sweden.
Scand J Immunol. 2012 Jul;76(1):49-53. doi: 10.1111/j.1365-3083.2012.02702.x.
The study was designed to investigate whether complement is activated in patients subject to rectal surgery and whether the choice of surgical technique (open or laparoscopic) has any impact on the activation of complement. Our hypothesis is that laparoscopic surgery leads to a lower-level activation of complement than open surgery. Patients (n = 24) subject to rectal surgery owing to rectal cancer were included. The study was prospective and randomized. The patients were randomized to either laparoscopic surgery (n = 12) or open surgery (n = 12). Blood samples for determination of complement activation (C4d, Bb, C3bc and the terminal C5b-9 complex TCC) were drawn before start of surgery (T0) and at the following time-points after start of surgery: 180 min (T1), 360 min (T2), 24 h (T3) and 3-5 days (T4). A significant increase in the alternative pathway activation product Bb and in the terminal pathway activation product TCC was seen over time in both groups (P < 0.001). Bb peaked early (T1) and returned to baseline levels post-operatively, whereas TCC increased steadily with maximum values in the late post-operative period. The plasma concentrations of C4d and C3bc decreased significantly in both groups at T1 and T2 and returned to baseline levels at T4. There was no significant difference between the groups. Rectal surgery causes activation of the complement system. Complement is activated through the alternative pathway. Results mostly showed no significant differences between laparoscopic and open rectal surgery apart from lower levels of factor Bb in the former group in the perioperative period.
本研究旨在探讨接受直肠手术的患者是否会激活补体，以及手术技术（开放手术或腹腔镜手术）的选择是否会对补体的激活产生影响。我们的假设是，腹腔镜手术导致补体的激活程度低于开放手术。因直肠癌接受直肠手术的患者（n=24）纳入本研究。本研究为前瞻性、随机研究。患者被随机分为腹腔镜手术组（n=12）或开放手术组（n=12）。在手术开始前（T0）和手术开始后以下时间点抽取用于确定补体激活的血样（C4d、Bb、C3bc 和末端 C5b-9 复合物 TCC）：180 分钟（T1）、360 分钟（T2）、24 小时（T3）和 3-5 天（T4）。两组患者的替代途径激活产物 Bb 和末端途径激活产物 TCC 均随时间呈显著增加（P<0.001）。Bb 在早期（T1）达到峰值并在术后恢复至基线水平，而 TCC 则逐渐增加，在术后晚期达到最大值。两组患者的 C4d 和 C3bc 血浆浓度在 T1 和 T2 时显著降低，在 T4 时恢复至基线水平。两组之间无显著差异。直肠手术会引起补体系统的激活。补体通过替代途径被激活。除了腹腔镜组患者在围手术期 Bb 因子水平较低外，腹腔镜和开放直肠手术的结果基本没有显著差异。
