Agnifili A, Ibi I, Guadagni S, Verzaro R, Gianfelice F, Mancini E, De Bernardinis G, Silvi B, Leonardis F
Cattedra di Chirurgia Generale, Università degli Studi de L'Aquila.
G Chir. 1993 Sep;14(7):344-8.
Pain and endocrine-metabolic response to surgical stress, during surgery and in the early postoperative period, was compared in two groups of patients affected by gallstones and randomly assigned to Laparoscopic Cholecystectomy or Open Cholecystectomy. Pain was assessed by the VAS method also taking into account the need of analgesic administration in the postoperative period. The so called "stress hormones" (Prolactin (PRL), Cortisol (CORT), Human Growth Hormone (HGH)) and glycaemia were monitored during surgery and in the first postoperative 24 hours. The minimal invasive technique of laparoscopic cholecystectomy accounted for a very limited analgesic administration. In the intraoperative period laparoscopic cholecystectomy plasma hormone levels overlapped the open cholecystectomy ones, while in the postoperative period a constant increase in PRL and CORT levels was registered in the open cholecystectomy group demonstrating a prolonged stressful condition. The end results of this study show that laparoscopic cholecystectomy has major advantages than open cholecystectomy in the treatment of gallstones as far as pain and endocrine-metabolic response are concerned.
对两组胆结石患者进行比较，这两组患者被随机分配接受腹腔镜胆囊切除术或开腹胆囊切除术，观察手术期间及术后早期手术应激引起的疼痛和内分泌代谢反应。采用视觉模拟评分法（VAS）评估疼痛，并考虑术后镇痛药物的使用情况。在手术期间及术后24小时内监测所谓的“应激激素”（催乳素（PRL）、皮质醇（CORT）、人生长激素（HGH））和血糖。腹腔镜胆囊切除术这种微创技术所需的镇痛药物用量非常有限。术中，腹腔镜胆囊切除术组的血浆激素水平与开腹胆囊切除术组的重叠，而术后，开腹胆囊切除术组PRL和CORT水平持续升高，表明应激状态持续时间较长。本研究的最终结果表明，就疼痛和内分泌代谢反应而言，腹腔镜胆囊切除术在治疗胆结石方面比开腹胆囊切除术具有更大优势。
