Krog Anne H, Thorsby Per M, Sahba Mehdi, Pettersen Erik M, Sandven Irene, Jørgensen Jørgen J, Sundhagen Jon O, Kazmi Syed S H
a Institute of Clinical Medicine, University of Oslo , Oslo , Norway.
b Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases , Oslo University Hospital , Oslo , Norway.
Scand J Clin Lab Invest. 2017 Apr;77(2):83-92. doi: 10.1080/00365513.2016.1268264. Epub 2017 Jan 9.
Minimally invasive surgery seems to reduce hormonal stress response to surgery, but has not previously been examined in major abdominal vascular surgery. Aortic cross-clamping time and operation time is known to be longer in the totally laparoscopic aortobifemoral bypass (LABF) as compared to open aortobifemoral bypass (OABF). The main objective of our study was to measure the hormonal stress response during surgery and aortic cross-clamping in patients undergoing a totally laparoscopic versus an open aortobifemoral bypass. This was a sub-study of a larger randomized controlled multicentre trial. Thirty consecutive patients with severe aortoiliac occlusive disease were randomized to either a laparoscopic (LABF) or an open (OABF) procedure. The surgical stress response was measured by perioperative monitoring of adrenocorticotropic hormone (ACTH), aldosterone, metanephrine and cortisol at eight different time-points. During surgery. there was an increase in all humoral stress markers in both groups. The analysis of covariance showed increased levels of cortisol and ACTH in open group at 24 h time-point as compared to the baseline and this difference was statistically significant between the two groups, which indicate an earlier return to baseline levels in the laparoscopic group. Results from the General Estimated Equations (GEE) model indicate that LABF generates a lower level of metanephrine and higher level of aldosterone as compared to OABF. In conclusion, although they have higher levels of ACTH, aldosterone and cortisol during surgery, the patients operated with a laparoscopic aortobifemoral bypass achieve earlier hormonal homeostasis after surgery compared to open aortobifemoral bypass.
微创手术似乎能降低手术引起的激素应激反应，但此前尚未在大型腹部血管手术中进行过研究。与开放性主动脉双股动脉旁路移植术（OABF）相比，完全腹腔镜主动脉双股动脉旁路移植术（LABF）的主动脉阻断时间和手术时间更长。我们研究的主要目的是测量接受完全腹腔镜与开放性主动脉双股动脉旁路移植术患者在手术和主动脉阻断期间的激素应激反应。这是一项更大规模随机对照多中心试验的子研究。连续30例患有严重主髂动脉闭塞性疾病的患者被随机分为腹腔镜手术组（LABF）或开放手术组（OABF）。通过在八个不同时间点围手术期监测促肾上腺皮质激素（ACTH）、醛固酮、间甲肾上腺素和皮质醇来测量手术应激反应。在手术期间，两组所有体液应激标志物均升高。协方差分析显示，与基线相比，开放组在24小时时间点的皮质醇和ACTH水平升高，两组之间的差异具有统计学意义，这表明腹腔镜组更早恢复到基线水平。广义估计方程（GEE）模型的结果表明，与OABF相比，LABF产生的间甲肾上腺素水平较低，醛固酮水平较高。总之，尽管接受腹腔镜主动脉双股动脉旁路移植术的患者在手术期间的ACTH、醛固酮和皮质醇水平较高，但与开放性主动脉双股动脉旁路移植术相比，他们术后能更早实现激素稳态。
