Borges Marisa de Carvalho, Takeuti Tharsus Dias, Terra Guilherme Azevedo, Ribeiro Betânia Maria, Rodrigues-Júnior Virmondes, Crema Eduardo
Department of Surgery, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil.
Department of Immunology, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil.
Arq Bras Cir Dig. 2016 Jul-Sep;29(3):164-169. doi: 10.1590/0102-6720201600030009.
Surgical trauma triggers an important postoperative stress response characterized by significantly elevated levels of cytokines, an event that can favor the emergence of immune disorders which lead to disturbances in the patient's body defense. The magnitude of postoperative stress is related to the degree of surgical trauma.
To evaluate the expression of pro-inflammatory (TNF-α, IFN-γ, IL-1β, and IL-17) and anti-inflammatory (IL-4) cytokines in patients submitted to conventional and single-port laparoscopic cholecystectomy before and 24 h after surgery.
Forty women with symptomatic cholelithiasis, ranging in age from 18 to 70 years, participated in the study. The patients were divided into two groups: 21 submitted to conventional laparoscopic cholecystectomy and 19 to single-port laparoscopic cholecystectomy.
Evaluation of the immune response showed no significant difference in IFN-γ and IL-1β levels between the groups or time points analyzed. With respect to TNF-α and IL-4, serum levels below the detection limit (10 pg/ml) were observed in the two groups and at the time points analyzed. Significantly higher postoperative expression of IL-17A was detected in patients submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels (p=0.0094).
Significant postoperative expression of IL-17 was observed in the group submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels, indicating that surgical stress in this group was higher compared to the conventional laparoscopic cholecystectomy.
手术创伤会引发重要的术后应激反应，其特征是细胞因子水平显著升高，这一事件可能有利于免疫紊乱的出现，进而导致患者身体防御功能紊乱。术后应激的程度与手术创伤的程度相关。
评估接受传统腹腔镜胆囊切除术和单孔腹腔镜胆囊切除术的患者在手术前及术后24小时促炎细胞因子（肿瘤坏死因子-α、干扰素-γ、白细胞介素-1β和白细胞介素-17）和抗炎细胞因子（白细胞介素-4）的表达情况。
40名年龄在18至70岁之间有症状胆结石的女性参与了该研究。患者被分为两组：21例行传统腹腔镜胆囊切除术，19例行单孔腹腔镜胆囊切除术。
免疫反应评估显示，在分析的组间或时间点，干扰素-γ和白细胞介素-1β水平无显著差异。关于肿瘤坏死因子-α和白细胞介素-4，在分析的两组及时间点均观察到血清水平低于检测限（10 pg/ml）。与术前水平相比，接受单孔腹腔镜胆囊切除术的患者术后白细胞介素-17A的表达显著更高（p = 0.0094）。
与术前水平相比，接受单孔腹腔镜胆囊切除术的组术后白细胞介素-17表达显著，表明该组的手术应激高于传统腹腔镜胆囊切除术。
