Engin A, Bozkurt B S, Ersoy E, Oguz M, Gökçora N
Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
Surg Laparosc Endosc. 1998 Dec;8(6):435-7.
This study examined the selected hormonal responses to, and hormone-mediated glucose metabolism during minimally invasive surgery in, patients undergoing laparoscopic cholecystectomy for symptomatic gallstone disease. Thirty-two patients with symptomatic gallstone disease were included in this study and scheduled for open or laparoscopic procedure in a randomized trial. Results are expressed as mean and standard error of the mean. Statistical evaluations were performed with Mann-Whitney U and Wilcoxon signed-rank tests. Blood cortisol, glucagon, insulin, and glucose concentrations were measured immediately in the preoperative period and 6 h after surgery. Blood cortisol, glucagon, and glucose concentrations increased significantly after open and minimally invasive surgery, while insulin levels and the insulin:glucagon ratio remained unchanged. The rise of glucagon and cortisol values was found to be significantly higher in the postoperative period of the open procedure, than in the laparoscopic approach. However, in the patients who underwent open surgery, the increase in glucose concentrations was not significantly higher in the postoperative period. Surgery-induced hormonal effects on the islets increase glucagon and suppress insulin secretion. The glucagon-mediated increase in hepatic glucose production is excluded by the posttraumatic insulin levels from the insulin-sensitive tissues. A bihormonal setting favors a greater rate of hepatic glucose production in both open and laparoscopic surgery. Hormonal changes do reflect the degree of surgical stress, but their metabolic consequences are not parallel to the grade of surgical trauma in minimally invasive surgery.
本研究调查了因有症状胆结石疾病而接受腹腔镜胆囊切除术的患者在微创手术期间对所选激素的反应以及激素介导的葡萄糖代谢情况。本研究纳入了32例有症状胆结石疾病患者，并将其随机安排进行开放手术或腹腔镜手术。结果以平均值和平均标准误差表示。采用曼-惠特尼U检验和威尔科克森符号秩检验进行统计评估。在术前和术后6小时立即测量血皮质醇、胰高血糖素、胰岛素和葡萄糖浓度。开放手术和微创手术后，血皮质醇、胰高血糖素和葡萄糖浓度显著升高，而胰岛素水平和胰岛素：胰高血糖素比值保持不变。发现开放手术术后胰高血糖素和皮质醇值的升高显著高于腹腔镜手术。然而，接受开放手术的患者术后葡萄糖浓度的升高并不显著。手术引起的对胰岛的激素作用增加了胰高血糖素并抑制胰岛素分泌。创伤后胰岛素水平排除了胰岛素敏感组织中胰高血糖素介导的肝葡萄糖生成增加。双激素环境有利于开放手术和腹腔镜手术中更高的肝葡萄糖生成率。激素变化确实反映了手术应激程度，但其代谢后果与微创手术中的手术创伤程度并不平行。
