Hackam D J, Rotstein O D
Department of Surgery, Toronto Hospital, Ont.
Can J Surg. 1998 Apr;41(2):103-11.
Minimal access surgery has revolutionized the treatment of a variety of surgical diseases, partly because it is associated with less patient morbidity than nonlaparoscopic surgical procedures. Emerging evidence suggests that alteration in the host response after laparoscopic procedures has significantly contributed to the improved postoperative course. Laparoscopy modulates both afferent stimuli (including tissue trauma, pain and wound size) and efferent responses (via neuroendocrine, metabolic, immunologic and cardiorespiratory systems). These effects lead to a decrease in postoperative pain, fever and disability. Laparoscopy mediates these effects through reduced wound size, the activities of endotoxin and immunomodulatory actions of the insufflated gas, resulting in impaired macrophage activity. Although clearly beneficial in reducing postoperative morbidity after elective surgery, this immunosuppression could increase the risk of complications during procedures for infection or neoplasia.
微创手术彻底改变了多种外科疾病的治疗方式，部分原因是与非腹腔镜手术相比，它给患者带来的发病率更低。新出现的证据表明，腹腔镜手术后宿主反应的改变显著改善了术后病程。腹腔镜检查可调节传入刺激（包括组织创伤、疼痛和伤口大小）和传出反应（通过神经内分泌、代谢、免疫和心肺系统）。这些作用导致术后疼痛、发热和残疾的减少。腹腔镜检查通过减小伤口大小、内毒素的活性以及注入气体的免疫调节作用来介导这些效应，从而导致巨噬细胞活性受损。尽管在降低择期手术后的发病率方面明显有益，但这种免疫抑制可能会增加感染或肿瘤手术过程中出现并发症的风险。
