Iwanaka T, Arkovitz M S, Arya G, Ziegler M M
Surgical Discipline Committee, Children's Cancer Group, Arcadia, Calif, USA.
J Am Coll Surg. 1997 Apr;184(4):357-63.
Laparoscopic operative procedures have decreased postoperative pain and the length of hospitalization. In addition, evidence supports a physiologic benefit from laparoscopic surgery. By analyzing several parameters of peritoneal macrophage function, we report a comparison of the magnitude of postoperative stress between two types of minimally invasive access techniques contrasted with an open laparotomy, in a murine model.
Immature male A/J mice were exposed to pneumoperitoneum using carbon dioxide, gasless suspension, or laparotomy. Peritoneal macrophages were then harvested, and the number and viability of the macrophages from each group of mice were compared. Last, as a marker of postoperative stress, the in vitro production of nitric oxide and tumor necrosis factor alpha by these macrophages was determined.
The number of peritoneal macrophages and the viability of the macrophages in the laparotomy group were significantly decreased 4 hours after operation compared with the minimally invasive and control groups. In addition, macrophage production of tumor necrosis factor alpha and nitric oxide, two markers of macrophage stress, 24 hours after operation was significantly increased in the laparotomy group compared with animals serving as controls. Gasless suspension and pneumoperitoneum decreased the number of macrophages to a lesser degree than did open laparotomy and did not affect macrophage viability. Moreover, gasless suspension and pneumoperitoneum did not lead to an increase in tumor necrosis factor alpha or nitric oxide production by peritoneal macrophages.
Postoperative stress, assessed by a decrease in macrophage viability and an increase in cytotoxic cytokine production, is maximized after laparotomy compared with stress in murine hosts that underwent minimally invasive treatment. These data provide basic scientific evidence for the possible physiologic benefit of minimally invasive techniques.
腹腔镜手术操作减少了术后疼痛和住院时间。此外，有证据支持腹腔镜手术具有生理益处。通过分析腹膜巨噬细胞功能的几个参数，我们在小鼠模型中报告了两种微创入路技术与开腹手术相比术后应激程度的比较。
将未成熟雄性A/J小鼠暴露于二氧化碳气腹、无气悬吊或开腹手术中。然后收集腹膜巨噬细胞，比较每组小鼠巨噬细胞的数量和活力。最后，作为术后应激的标志物，测定这些巨噬细胞体外产生一氧化氮和肿瘤坏死因子α的情况。
与微创组和对照组相比，开腹手术组术后4小时腹膜巨噬细胞数量和巨噬细胞活力显著降低。此外，与对照组动物相比，开腹手术组术后24小时巨噬细胞应激的两个标志物肿瘤坏死因子α和一氧化氮的产生显著增加。无气悬吊和气腹使巨噬细胞数量减少的程度小于开腹手术，且不影响巨噬细胞活力。此外，无气悬吊和气腹不会导致腹膜巨噬细胞产生肿瘤坏死因子α或一氧化氮增加。
与接受微创治疗的小鼠宿主相比，开腹手术后通过巨噬细胞活力降低和细胞毒性细胞因子产生增加评估的术后应激最大。这些数据为微创技术可能的生理益处提供了基础科学证据。
