Johnson M A, Gadacz T R, Pfeifer E A, Given K S, Gao X
Department of Surgery, Medical College of Georgia, Augusta 30912, USA.
Am Surg. 1997 Jan;63(1):13-6.
Lasers and electrocautery devices have been applied as an alternative to the scalpel because of better hemostasis and lymphatic sealing. However, previous studies have demonstrated conflicting data regarding the effects of these modalities on the inflammatory response, the first reaction by tissue during wound healing. The purpose of this study is to quantitate inflammatory responses in rat skin following laser, electrocautery, and scalpel injury by measuring T-kininogen (T-KGN), a major acute-phase protein in the rat and its endogenous substrate, cathepsin B, an important inflammatory mediator. Full-thickness wounds (6 cm) were created on the dorsum of Sprague Dawley rats by using a laser, electrocautery, or scalpel. Tissue samples were harvested at 1 hour to 21 days after injury. T-KGN levels were radioimmunoassayed; cathepsin B activity was assayed by using a synthetic substrate Z-Arg-Arg-MCA. Data were analyzed by analysis of variance. T-KGN levels peaked at 3 days for all modalities, although the laser group was statistically (P < or = 0.01) higher at 1, 3, and 7 days after injury. In contrast, cathepsin B activity was significantly (P < or = 0.01) lower at 3 days in the laser group. CO2 laser ablation incites a greater inflammatory response than electrocautery or scalpel injuries. High levels of T-KGN may provide protection from proteolytic damage associated with cathepsins.
由于具有更好的止血和淋巴管封闭作用，激光和电灼设备已被用作手术刀的替代品。然而，先前的研究表明，关于这些方式对炎症反应（伤口愈合过程中组织的第一反应）的影响的数据存在冲突。本研究的目的是通过测量大鼠主要急性期蛋白T-激肽原（T-KGN）及其内源性底物组织蛋白酶B（一种重要的炎症介质），来定量大鼠皮肤在激光、电灼和手术刀损伤后的炎症反应。通过使用激光、电灼或手术刀在Sprague Dawley大鼠的背部制造全层伤口（6厘米）。在损伤后1小时至21天采集组织样本。用放射免疫分析法测定T-KGN水平；使用合成底物Z-Arg-Arg-MCA测定组织蛋白酶B活性。数据采用方差分析进行分析。所有方式的T-KGN水平在3天时达到峰值，尽管激光组在损伤后1天、3天和7天在统计学上（P≤0.01）更高。相比之下，激光组在3天时组织蛋白酶B活性显著（P≤0.01）较低。二氧化碳激光消融引发的炎症反应比电灼或手术刀损伤更大。高水平的T-KGN可能提供保护，防止与组织蛋白酶相关的蛋白水解损伤。
