Schauer P R, Sirinek K R
Department of Surgery, University of Texas Health Science Center at San Antonio.
Am Surg. 1995 Feb;61(2):106-11.
The purpose of this study was to prospectively determine and compare the effect of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) on the neuroendocrine response to surgical trauma. Twenty-three evenly matched patients were assigned to either OC (11) or LC (12). Plasma concentrations of norepinephrine (NEPI), epinephrine (EPI), dopamine (DOPA), total catecholamine (TCAT), cortisol, and glucose were measured before and up to 9 hours after skin incision. Compared with preoperative values, significant (P < 0.05) increases in the plasma concentrations of catecholamines, cortisol, and glucose occurred shortly after skin incision following both LC and OC. Compared to post-incision values for OC patients, the increases in NEPI (3-9 hrs), EPI (2-9 hrs), DOPA (1-9 hrs), cortisol (4-9 hrs) and glucose (4-9 hrs) were significantly (P < 0.05) less following LC. Levels of these stress indicators returned to baseline by 4-5 hrs after LC but remained elevated for 9 hrs after OC. The laparoscopic approach results in a significantly reduced neuroendocrine response to surgical trauma following cholecystectomy. The laparoscopic technique may be the best surgical approach in critically ill patients requiring cholecystectomy or other intraabdominal procedures.
本研究的目的是前瞻性地确定并比较腹腔镜胆囊切除术（LC）与开腹胆囊切除术（OC）对外科手术创伤的神经内分泌反应的影响。23例匹配良好的患者被分配至OC组（11例）或LC组（12例）。在皮肤切开前及切开后长达9小时内，测量血浆去甲肾上腺素（NEPI）、肾上腺素（EPI）、多巴胺（DOPA）、总儿茶酚胺（TCAT）、皮质醇和葡萄糖的浓度。与术前值相比，LC和OC术后皮肤切开后不久，血浆儿茶酚胺、皮质醇和葡萄糖浓度均显著升高（P<0.05）。与OC患者的切开后值相比，LC术后NEPI（3 - 9小时）、EPI（2 - 9小时）、DOPA（1 - 9小时）、皮质醇（4 - 9小时）和葡萄糖（4 - 9小时）的升高显著降低（P<0.05）。这些应激指标的水平在LC术后4 - 5小时恢复至基线，但在OC术后9小时仍保持升高。腹腔镜手术方法导致胆囊切除术后对外科手术创伤的神经内分泌反应显著降低。对于需要进行胆囊切除术或其他腹部手术的重症患者，腹腔镜技术可能是最佳的手术方法。
