Length of laparotomy incision and surgical stress assessed by serum IL-6 level

BACKGROUND: Because surgical stress is thought to have an effect on morbidity, mortality, and remnant tumour progression after surgery, diminishing surgical stress is important. The purpose of this study was to assess in a murine model whether the length and type of laparotomy incision influence surgical stress. METHODS: Serum IL-6 concentrations were measured sequentionally in 220 male BALB/c mice who were assigned to different basic laparotomies, (1-cm versus 2-cm versus 3-cm laparotomy with or without caecal resection), other types of laparotomy (3-cm, 1-cm x 3, 3-cm transverse, 3-cm laparotomy with rapid closure), or 3-cm skin incision with or without laparotomy. The serum level of IL-6 was measured by ELISA. RESULTS: Serum IL-6 levels at 3 and 6h after surgery were significantly higher in the 3-cm laparotomy group (1,680+/-802pg/ml and 1,066+/-507pg/ml, respectively), than in the 1-cm laparotomy group (797+/-427pg/ml and 515+/-212pg/ml, respectively). When caecal resection was added, the serum IL-6 level at 6h was significantly higher in the 3-cm laparotomy group (2,844+/-134pg/ml) than in the 1-cm laparotomy group (2,200+/-379pg/ml). Although the type of laparotomy incision was not associated with the serum level of IL-6, the serum IL-6 level after midline skin incision without laparotomy (245+/-142pg/ml) was significantly lower than that after 3-cm laparotomy (1,680+/-802pg/ml). CONCLUSIONS: The length of laparotomy incision was correlated with the serum level of IL-6 in a murine model. The surgical stress related to abdominal procedures might be decreased when laparotomy wounds are kept as small as possible.     

Laparoscopic insufflation with room air causes exaggerated interleukin-6 response

Background: The gut is a central organ in the postoperative stress reaction. We previously reported that measuring gut-mucosal cytokines may more accurately reflect the response to operative stress. Additionally, we have shown that the gut demonstrates a blunted cytokine response after laparoscopy as compared with laparotomy. Methods: To further investigate whether this differential response is caused by exposure of the peritoneal cavity to general atmospheric air during laparotomy, 80 A/J mice were randomized equally into four groups: CD (carbon dioxide [CO₂] pneumoperitoneum), RA (room air pneumoperitoneum), AP (anesthesia and port insertion only), and PC (pure control, no intervention). Pneumoperitoneum was established and maintained at 3 mmHg for 60 min. All the mice were killed 4 h after the intervention. Jejunal mucosa and serum samples were collected and analyzed for interleukin-6 (IL-6) levels. Results were analyzed by analysis of variance (ANOVA). Results: Gut-mucosal IL-6 in the RA group was significantly higher than in all other groups: RA, 1,354.5 ± 117.9* vs. CD, 964.3 ± 114.0 vs. AP, 960.2 ± 86.2 vs. PC, 908.0 ± 83.6; *p < 0.05. The CD group did not show a significant increase in gut-mucosal IL-6 as compared with the AP and PC groups. Similarly, RA resulted in significant increases in serum IL-6 as compared with AP and PC, whereas CD showed no significant difference: RA, 161.3 ± 66.2* vs. 95.1 ± 1 vs. AP, 10.6 ± 5.3 vs. PC, undetectable; *p < 0.05. There was no difference in serum IL-6 level between CD or any of the other groups. Conclusions: Exposure of the peritoneal cavity to atmospheric air, independently of the trauma of abdominal access, causes an exaggerated serum and gut mucosal IL-6 response 4 h after intervention. The beneficial effect of CO₂ laparoscopy may be caused by the exclusion of general atmospheric air from the peritoneal cavity. Received: 29 June 1998/Accepted: 1 November 1998     

Plasma and dialysate IL-6 and VEGF concentrations are associated with high peritoneal solute transport rate.

BACKGROUND: It has been speculated that increased levels of circulating or intraperitoneal pro-inflammatory cytokines such as interleukin 6, and pro-angiogenic vascular endothelial growth factor (VEGF) may contribute to high peritoneal small-solute transport rate (PSTR) in continuous ambulatory peritoneal dialysis (CAPD) patients. In this study we evaluated possible relationships between plasma and dialysate IL-6 and VEGF levels and PSTR. METHODS: Forty CAPD patients (mean age+/-SD of 58+/-14 years) with no apparent inflammation process or disease, who had been on CAPD for 19+/-15 months (range 3-56 months) were included in the study. Peritoneal equilibration test (PET) was used to evaluate PSTR. Patients were divided into two groups: high-average and high transporters (H/A; D/P(creat)>/=0.65) and low-average and low transporters (L/A; D/P(creat)<0.64). Albumin and IgG clearances were used in the evaluation of permeability to larger solutes. Plasma and overnight dialysate levels of IL-6 and VEGF were measured. RESULTS: Plasma IL-6 (7.6 vs 4.3 pg/ml) and VEGF (342 vs 163 pg/ml) as well as dialysate IL-6 (174 vs 80 pg/ml) and VEGF (96 vs 69 pg/ml) levels were significantly higher in the H/A than in the L/A group. The dialysate appearance of IL-6 and VEGF correlated with D/P(creat), as well as with albumin and IgG clearances. Moreover, significant correlations were noted between dialysate IL-6 and dialysate VEGF levels. CONCLUSIONS: The findings of (i) increased plasma and dialysate levels of IL-6 and VEGF in the H/A group compared to the L/A group, (ii) an association between PSTR and both plasma and dialysate IL-6 and VEGF levels, and (iii) a significant correlation between dialysate IL-6 and VEGF concentrations suggest that inflammation, angiogenesis, and peritoneal transport may be interrelated and involved in the pathophysiology of high PSTR in CAPD patients. However, due to the cross-sectional design of this study, the cause and effect relationships between plasma and dialysate IL-6 and VEGF concentrations and high PSRT remain unclear.     

Laparoscopic-assisted cecectomy is associated with decreased formation of postoperative pulmonary metastases compared with open cecectomy in a murine model

BACKGROUND: It was shown in a murine model that sham laparotomy is associated with a higher incidence of postoperative lung metastases when compared with results seen after carbon dioxide pneumoperitoneum. Using the same tumor model, the present study was undertaken to determine if the addition of bowel resection to the operative procedure would impact the results. METHODS: Sixty mice underwent anesthesia alone (anesthesia control [AC]), laparoscopic-assisted cecectomy (LC), or open cecectomy (OC). After surgery, all animals received tail vein injections of 105 TA3-Ha tumor cells. On postoperative day 14, the lungs and trachea were excised en bloc and processed, and surface lung metastases were counted and recorded by a blinded observer. RESULTS: The mean number of surface lung metastases in the AC, LC, and OC groups was 30.9, 76.3, and 134.5, respectively. Significantly more metastases were documented after OC (P<.001) and LC (P<.05) than after anesthesia alone. Mice in the LC group had significantly fewer lung metastases (43% less) than mice in the OC group (P<.01). CONCLUSIONS: OC was associated with significantly more lung metastases than either LC or AC. Surgery-related immune suppression or trophic tumor cell stimulation occurring after surgery may contribute to this phenomenon.     

Bone-Resorbing Cytokines from Peripheral Blood Mononuclear Cells after Hormone Replacement Therapy: A Longitudinal Study

Conflicting results have been reported in several cross-sectional studies measuring cytokine production from adherent monocytes in pre- and postmenopausal women. Furthermore, the target cells for the action of estrogen are still debated. We therefore assessed in a longitudinal manner the cytokine production from different fractions of peripheral blood mononuclear cells (PBMC) cultured for 48 h. PBMC were obtained from 30 postmenopausal women before and after 6 months of hormone replacement therapy (HRT). Women were randomly allocated to two groups: an adherent PBMC group (n= 20) and a total PBMC group (n= 9). After 6 months of treatment, urinary pyridinoline levels were markedly decreased in both groups (353 ± 24 vs 114 ± 13 μg/mmol creatinine and 325 ± 35 vs 164 ± 31 μg/mmol creatinine respectively, p<0.01). Culture supernatants were assayed for interleukin 1β (IL-1β), interleukin 6 (IL-6), soluble IL-6 receptor (IL-6rs) and tumor necrosis factor alpha (TNF-α). In the adherent PBMC group, HRT induced a nonsignificant trend toward decreased levels of IL-1β (35 ± 10 vs 13 ± 5 pg/ml), TNF-α (333 ± 58 vs 222 ± 30 pg/ml) and IL-6 (115 ± 70 vs 17 ± 10 pg/ml). In contrast, in the total PBMC group, HRT induced a consistent and dramatic decrease in levels of IL-1β (104 ± 22 vs 25 ± 8 pg/ml), IL-6 (5950 ± 1041 vs 1011 ± 361 pg/ml), IL-6rs (148 ± 33 vs 35 ± 12 pg/ml) (p<0.01) and TNF-α (1468 ± 315 vs 585 ± 207 pg/ml, p= 0.05). We then evaluated whether HRT had the same effect in vitro. Adherent or total PBMC of 8 postmenopausal women were cultured with or without 10⁻⁸M 17β-estradiol or tibolone for 48 h. Production of IL-1β, TNF-α, IL-6 and IL-6rs was not affected by the presence of 17β-estradiol or tibolone in cultures of these cell fractions. In conclusion, our data indicate that non-adherent PBMC could mediate the response to HRT. HRT may exert its action indirectly via noncirculating cells, as suggested by the absence of an in vitro effect. Received: 11 July 2000 / Accepted: 15 January 2001     

Systemic acute-phase response after laparoscopic and open cholecystectomy

BACKGROUND: Cytokines are the main mediators of inflammation and the response to trauma. The purpose of this study was to compare variations in cytokine levels following laparoscopic cholecystectomy (LC) and mini-laparotomy cholecystectomy (OC), since these two types of operations were considered to be a unique model for examining the role of local tissue injury in postoperative inflammatory reactions. METHODS: A total of 40 patients were studied. Eighteen of them underwent LC; the remaining 22 were operated on using the open technique. Systemic concentrations of interleukin-6 (IL-6), interleukin-1 (IL-1), tumor necrosis factor (TNF), and C-reactive protein (CRP) were measured before and after the operation. In addition, we compared pre- and postoperative white blood cell (WBC) counts, postoperative body temperature, and length of postoperative hospitalization. RESULTS: There was no difference between the two groups in IL-1 and TNF response. The rise in plasma IL-6 levels (18.86 +/- 9.61 vs 5.00 +/- 0.0 pg/ml, p < 0.0001) and CRP (8.40 +/- 5.81 vs 1.43 +/- 1.30 mg/dl, p < 0.001) were more marked after open cholecystectomy than after the laparoscopic procedure. There was no correlation between serum CRP concentrations and the other postoperative parameters. CONCLUSION: The magnitude of the acute-phase response was less pronounced following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.     

Relationship Between Cytokine Gene Polymorphisms and Risk of Postoperative Pneumonia with Esophageal Cancer

Background

We retrospectively evaluated the relationship between cytokine gene polymorphisms and development of postoperative pneumonia after esophagectomy.

Methods

In 120 patients who underwent esophagectomy, serum samples were obtained to measure levels of serum interleukin (IL)-6 and IL-10 at four time points (preoperatively, postoperative day (POD)0, POD1, and POD3). DNA extracted from peripheral blood in all patients was analyzed to determine polymorphisms of cytokines such as tumor necrosis factor-α -1031 T/C, IL-1β -511C/T, IL-6 -634C/G, and IL-10 -819 T/C.

Results

Postoperative pneumonia arose in 34 patients (28.3 %). Perioperative serum IL-10 levels were significantly higher for IL-10 -819 C/T?+?C/C genotypes than for T/T genotypes (POD0 16.7?±?2.84 vs. 8.54?±?0.87 pg/ml, p?=?0.0002; POD1 14.0?±?2.64 vs. 8.8?±?0.87 pg/ml, p?=?0.0143; POD3 8.9?±?2.67 vs. 4.4?±?0.52 pg/ml, p?=?0.0076). The frequency of the IL-10 -819 T/T genotype was significantly higher in patients with postoperative pneumonia than in patients without pneumonia (p?=?0.0323). Multivariate analysis of factors such as sex, smoking, length of operation, field of lymph node dissection, and IL-10 polymorphism identified IL-10 polymorphism as independent predictor of postoperative pneumonia.

Conclusions

Patients with IL-10 -819 T/T genotype may be at high risk for postoperative pneumonia after esophagectomy.     

Comparison of laparoscopic versus open cholecystectomy in patients with cardiac valve replacement

To evaluate the benefits and safety of laparoscopic cholecystectomy (LC) in patients with cardiac valve replacement (which frequently leads to cholelithiasis), 12 patients with cholelithiasis associated with cardiac valve replacement were studied. The patients were divided into two groups, of 6 patients each, according to the type of operation performed, open cholecystectomy (OC) or LC. The postoperative course was monitored with respect to laboratory data on postoperative days (POD) 1, 3, and 7. The mean duration of operation, blood loss, days to food resumption, length of hospital stay, and morbidity were compared between the two groups. Significant differences (P < 0.05) were found between the OC and LC groups in white blood cell counts on POD 1 (12 980 ± 3040/mm³ vs 8300 ± 1590/mm³), days to food resumption (2.7 ± 0.4 days vs 1.0 ± 0.7 days), and length of postoperative stay (15.8 ± 1.0 days vs 10.8 ± 1.6 days). There were no complications in the LC group, but 1 patient in the OC group had heart failure postoperatively. Our findings indicate the efficacy and safety of LC in patients with cardiac valve replacement. Received: August 14, 2000 / Accepted: December 22, 2000     

Systemic inflammation and immune response after laparotomy vs laparoscopy in patients with acute cholecystitis,complicated by peritonitis

AIM: To evaluate acute cholecystitis, complicated by peritonitis, acute phase response and immunological status in patients treated by laparoscopic or open approach. METHODS: From January 2002 to May 2012, we conducted a prospective randomized study on 45 consecutive patients (27 women, 18 men; mean age 58 years). These subjects were taken from a total of 681 patients who were hospitalised presenting similar preoperative findings: acute upper abdominal pain with tenderness, involuntary guarding under the right hypochondrium and/or in the flank; fever higher than 38 ℃, leukocytosis greater than 10 × 10 9 /L or both, and ultrasonographic evidence of calculous cholecystitis possibly complicated by peritonitis. These patients had undergone cholecystectomy for acute calculous cholecystitis,complicated by bile peritonitis. Randomly, 23 patients were assigned to laparoscopic cholecystectomy (LC), and 22 patients to open cholecystectomy (OC). Blood samples were collected from all patients before operation and at days 1, 3 and 6 after surgery. Serum bacteraemia, endotoxaemia, white blood cells (WBCs), WBC subpopulations, human leukocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin-1 (IL-1) and IL-6, and C-reactive protein (CRP) were measured at 0, 30, 60, 90, 120 and 180 min, at 4, 6, 12, 24 h, and then daily (8 A.M.) until post-operative day 6.RESULTS: The two groups were comparable in the severity of peritoneal contamination as indicated by the viable bacterial count (open group = 90% of positive cultures vs laparoscopic group = 87%) and endotoxin level (open group = 33.21 ± 6.32 pg/mL vs laparoscopic group = 35.02 ± 7.23 pg/mL). Four subjects in the OC group (18.1%) and 1 subject (4.3%) in the LC group (P < 0.05) developed intra-abdominal abscess. Severe leukocytosis (range 15.8-19.6/mL) was observed only after OC but not after LC, mostly due to an increase in neutrophils (days 1 and 3, P < 0.05). This value returned to the normal range within 3-4 d after LC and 5-7 d after OC. Other WBC types and lymphocyte subpopulations showed no significant variation. On the first day after surgery, a statistically significant difference was observed in HLA-DR expression between LC (13.0 ± 5.2) and OC (6.0 ± 4.2) (P < 0.05). A statistically significant change in plasma elastase concentration was recorded post-operatively at days 1, 3, and 6 in patients from the OC group when compared to the LC group (P < 0.05). In the OC group, the serum levels of IL-1 and IL-6 began to increase considerably from the first to the sixth hour after surgery. In the LC group, the increase of serum IL-1 and IL-6 levels was delayed and the peak values were notably lower than those in the OC group. Significant differences between the groups, for these two cytokines, were observed from the second to the twenty-fourth hour (P < 0.05) after surgery. The mean values of serum CRP in the LC group on post-operative days (1 and 3) were also lower than those in the OC group (P < 0.05). Systemic concentration of endotoxin was higher in the OC group at all intra-operative sampling times, but reached significance only when the gallbladder was removed (OC group = 36.81 ± 6.4 ρg/mLvs LC group = 16.74 ± 4.1 ρg/mL, P < 0.05). One hour after surgery, microbiological analysis of blood cultures detected 7 different bacterial species after laparotomy, and 4 species after laparoscopy (P < 0.05). CONCLUSION: OC increased the incidence of bacteraemia, endotoxaemia and systemic inflammation compared with LC and caused lower transient immunological defense, leading to enhanced sepsis in the patients examined.     

Interleukin 6 and interleukin 1 receptor antagonist as early markers of complications after lung cancer surgery.

OBJECTIVE: To assess changes of interleukin 6 (IL-6) and interleukin 1 receptor antagonist (IL-1ra) in serum, sputum, and drained pleural fluid of patients operated on due to lung cancer. METHODS: Twenty-seven patients treated with lobectomy or pneumonectomy, including 14 with complications and 13 without complications, were analyzed. Serum IL-6 and IL-1ra concentration was measured before, at the end of surgery, and on postoperative day 1, 3, and 7, by ELISA test. Additionally, concentration of IL-6 and IL-1ra was measured in sputum at the end of surgery and in pleural fluid on postoperative day 1. RESULTS: In the entire group serum concentrations of IL-6 and IL-1ra were significantly elevated after surgery, in comparison with preoperative values. Serum IL-6 concentration was higher in patients with complications only on day 7 (median 59.0 (range: 41.25-76.65) pg/ml vs 21.5 (9.87-35.0) pg/ml; p=0.012). Patients with complications had higher concentration of IL-6 in pleural fluid (91312 (51812-94872) pg/ml vs 2006 (1926-2108) pg/ml; p=0.00008). Serum IL-1ra concentration was higher in patients with complications on day 1 (1832.4 (1144.7-2362.2) pg/ml vs 1088.4 (817.5-1312.5) pg/ml; p=0.01). Concentration of IL-1ra in drained fluid was higher in patients with complications (68128.8 (48104-108564) pg/ml vs 16470 (15930-16875) pg/ml; p=0.0003). On day 1 after surgery a significant correlation between serum and pleural fluid concentration for IL-6 as well as for IL-1ra were observed (Spearman test for IL-6: r=0.47; p=0.02; for IL-1ra: r=0.48; p=0.02). CONCLUSIONS: Elevated concentrations of IL-6 and IL-1ra in pleural fluid on postoperative day 1 are promising early markers of postoperative complications. Elevated concentrations of IL-6 and IL-1ra in serum are good early markers of severity of surgical injury and may reflect development of postoperative complications.     

Correlation between levels of TNF-α and IL-6 and hematological involvement in SLE Egyptian Patients with lupus nephritis

Background Systemic lupus Erythematosus (SLE) is a rheumatic autoimmune disease characterized by multisystem organ involvement and by high titers of auto antibodies against several nuclear and cytoplasmic antigens. Numerous abnormalities of the cytokine network have been described in patients suffering from SLE. However the role of cytokines in different organ involvement is not yet well defined. Objective To determine if levels of Interlukin-6 (IL-6) and Tumor necrosis factor (TNF-α) correlate with SLE disease activity in Egyptian SLE patients and more specifically with hematological involvement. Methods Levels of TNF-α and IL-6 in serum samples from sixty individuals (40 with Systemic lupus Erythmatosus and 20 healthy controls) were determined and renal biopsies were obtained from SLE patients. Results Levels of TNF-α and IL-6 were higher in SLE patients with active compared with inactive hematological disease. Further analysis showed that this association was dependent on inverse correlation (P=0.017, r=−0.49) for IL-6 and (P=0.76, r=−.243) for TNF-α. The mean level of TNF-α and Il-6 was (766.95±357.82 pg/ml) and (135.4±54.23 pg/ml) respectively for patients with active disease while it was (314.01±100.87 pg/ml) and (47.33±18.61 pg/ml) for those with inactive disease and (172.7±39.19 pg/ml) and (21.15±10.99 pg/ml) for the healthy control group respectively. The difference was statistically significant (P=0.002). We found significant positive correlations between TNF-α and IL-6 and the SLE Disease Activity Index (SLEDAI) score. (r=+0.743 and +0.772 respectively). Conclusion Raised level of Il-6 and TNF-α may influence the development of anemia in Egyptian patients with Lupus Nephritis.     

Minimal increase in gut-mucosal interleukin-6 during laparoscopy

Background: The gut clearly plays a significant role in postoperative recovery. Other investigators have shown an increase in gut-mucosal cytokines in septicemia and burn models. We tested the effects of laparotomy and laparoscopy on gut-mucosal IL-6 production. Methods: A/J mice were randomized to three groups: control, laparotomy plus bowel manipulation (OBM), and laparoscopy plus bowel manipulation (LBM). Serum and gut-mucosal samples obtained at 4 and 8 h after surgery were analyzed for IL-6. Results: We found that OBM is associated with increased serum and gut-mucosal IL-6 at both 4 and 8 h after surgery. In contrast, LBM showed a blunted response in serum IL-6 and no change in gut-mucosal IL-6 at both time intervals. Conclusions: We conclude that laparoscopy minimizes trauma to the peritoneal environment, thereby decreasing the gut's inflammatory response to operation. This differential response of the gut may partially explain the preservation of gut function following laparoscopy.     

腹腔镜与开腹手术治疗粘连性肠梗阻的对比研究

目的：比较腹腔镜与开腹手术治疗粘连性肠梗阻的临床效果。方法：回顾分析1999年6月至2006年6月施行腹腔镜手术治疗粘连性肠梗阻30例患者的临床资料,并与同期30例开腹手术对比分析。结果：平均手术时间腹腔镜组为（52±28）min,开腹手术组为（115±20）min,平均术中出血量分别为（30±15）ml和（150±35）ml,止痛剂平均用量分别为（20±18）ml和（60±19）ml,平均术后住院时间分别为（6±3）d和（11．8±4）d。腹腔镜组无一例发生并发症,开腹组发生7例,两组差异有统计学意义（P〈0．05）。结论：腹腔镜治疗粘连性肠梗阻有患者创伤小、术后康复快、并发症少及住院时间短等优点。     

Effect of laparotomy and laparoscopy on the establishment of lung metastasis in a murine model

BACKGROUND: Laparoscopic surgery is now applied to patients with gastrointestinal cancer. In animal studies, extraperitoneal tumor growth has been significantly less after laparoscopy than after laparotomy, but whether hematogenous metastasis occurs less frequently after laparoscopy is unknown. The aim of this study was to compare the frequency and growth of lung metastasis and serum levels of IL-6 and tumor necrosis factor-alpha (TNF-alpha) in mice treated by laparotomy and in mice treated by laparoscopy. METHODS: We used 182 male BALB/c mice. Colon 26 cancer cells (5 x 10(4)) were injected into the tail vein, and the mice were assigned to a laparotomy group (3-cm laparotomy), a laparoscopy group (carbon dioxide pneumoperitoneum at 6 to 8 mm Hg for 30 minutes), or a control group. Lung weight, number of lung metastases, and serum levels of IL-6 and TNF-alpha were measured and compared among the 3 groups. RESULTS: The lung weight and number of metastases on the lung surface and cut section in the laparotomy group (0.44+/-0.21 g, 55.7+/-46.7, 23.0+/-19.0) were significantly larger than those in the laparoscopy group (0.32+/-0.15 g, 29.9+/- 25.5, 13.1+/-9.9) or the control group (0.28+/-0.13, 29.3+/-26.2, 11.1+/-11.1). Three hours after the procedures, the serum level of IL-6 was significantly higher in the laparotomy group (1353 +/- 790 pg/mL) than in the laparoscopy group (671+/-353 pg/mL) or the control group (333+/-341 pg/mL). The lung weight, number of lung metastases, and levels of IL-6 and TNF-alpha were not different between the laparoscopy and control groups. CONCLUSIONS: Our results indicate that, although laparotomy accelerates tumor metastasis to the lung in this murine model, laparoscopy does not increase the frequency and growth of lung metastasis. The laparoscopic approach may suppress hematogenous metastasis to the lung because of decreased surgical stress and reduced cytokine response.     

腹腔镜胆囊、子宫联合切除术围手术期的处理(附78例报告)

目的:探讨腹腔镜胆囊、子宫联合切除术围手术期的处理措施。方法:回顾分析78例腹腔镜胆囊、子宫联合切除术的临床资料。78例中腹腔镜胆囊切除术联合腹腔镜子宫次全切除术45例,联合腹腔镜辅助阴式子宫切除术11例,联合全子宫切除术22例。结果:78例联合手术均获成功。手术时间(120.1±56.3)min,术中出血(288.1±102.5)ml,术后住院(6.1±2.0)d。无中转开腹及胆道、输尿管、膀胱损伤。结论:正确把握手术适应证,术前充分准备,熟练掌握操作技巧,术后妥善处理,腹腔镜子宫、胆囊联合切除术安全可行。     

腹腔镜与开腹直肠癌根治术对局部与全身免疫反应影响的对比研究

目的比较腹腔镜与开腹直肠癌手术对机体局部和全身炎症免疫反应的影响。方法 2005年4月～2006年2月40例直肠癌分为开腹组20例和腹腔镜组20例,术前第1天、术后第1天和第3天分别采集外周静脉血,测定C反应蛋白(CRP)、白细胞(WBC)、白介素6(IL-6)、CD4、CD8、自然杀伤细胞(NK细胞)和淋巴细胞,术后第1天和第3天腹腔引流液送检测定WBC、IL-6。结果腹腔镜与开腹直肠癌根治术对WBC、CD4、CD8、CD4/CD8、NK细胞和淋巴细胞的影响差异无显著性意义(P0.05)。开腹组术后第1、3天血CRP分别为(109.9±36.2)、(80.9±26.3)mg/L,显著高于腹腔镜组(83.9±37.7)mg/L(t=2.226,P=0.032),(58.6±30.4)mg/L(t=2.485,P=0.017)。开腹组术后第1、3天血IL-6分别为(92.6±21.0)、(71.6±18.4)pg/ml,显著高于腹腔镜组(73.7±20.9)pg/ml(t=2.853,P=0.007),(57.3±19.3)pg/ml(t=2.398,P=0.021)。2组术后第1、3天腹腔引流液WBC差异无显著性意义(P0.05),腹腔引流液IL-6开腹组术后第1天(164.8±54.0)pg/ml和术后第3天(121.6±45.9)pg/ml明显高于腹腔镜组术后第1天(128.3±55.4)pg/ml(t=-2.112,P=0.041)和术后第3天(90.7±48.2)pg/ml(t=-2.076,P=0.044)。腹腔镜组术中出血量(142.7±104.8)ml比开腹组(246.0±146.4)ml明显减少(t=-2.565,P=0.014),肠道功能恢复时间(51.0±19.1)h与开腹组相比明显缩短(81.1±21.6)h(t=-4.669,P=0.000),术后住院时间(10.7±2.8)d与开腹组(13.7±5.3)d相比差异有显著性(t=-2.238,P=0.031)。2组手术时间、肿瘤下切缘距离、肿瘤直径、清除淋巴结数和并发症比较无显著性意义(P0.05)。结论腹腔镜直肠癌根治术与开腹手术相比对机体炎症免疫反应的影响小,是一种安全、创伤小、恢复快的手术方式。     

CO_2气腹对大鼠重症急性胰腺炎胰腺病理变化及白介素1、2、6、10表达的影响

目的:探讨腹腔镜手术时CO2气腹对SD大鼠重症急性胰腺炎(severe acute pancreatitis,SAP)胰腺局部病变及血淀粉酶、炎症细胞因子白细胞介素1、2、6、10的影响。方法:随机将雄性SD大鼠50只分为3组:Ⅰ组20只(CO2组),胰胆管逆行注射5%牛磺胆酸钠,制备SAP动物模型,用气腹机向大鼠腹腔内注入CO2,压力12mm Hg,维持30min;Ⅱ组20只建立SAP模型后关腹,不充入CO2;Ⅲ组10只(对照组)开腹翻动胰腺后关腹。各组均于术后2.5h处死动物,对胰腺组织行病理学检查,并测定血淀粉酶、IL-1、IL-2、IL-6及IL-10的变化。结果:Ⅰ、Ⅱ、Ⅲ组的病理组织学评分分别为(1.900±0.370)、(1.750±0.259)及(0.000±0.000);淀粉酶(U/L)为(6 769±2 216)、(5 241±2 048)及(1 610±414);IL-1(pg/ml)为(0.241±0.052)、(0.320±0.067)及(0.143±0.057);IL-2(pg/ml)为(4.480±1.582)、(5.288±0.973)及(4.762±0.812);IL-6(pg/ml)为(176.39±41.75)、(206.10±37.29)及(115.14±24.96);IL-10(pg/ml)为(171.10±28.73)、(182.26±28.09)及(97.79±20.65)。与Ⅱ组相比,Ⅰ组的IL-1及IL-6表达明显降低(P<0.05),血清淀粉酶、IL-2、IL-10及胰腺病理组织学评分差异无统计学意义(P>0.05)。结论:CO2气腹对SD大鼠SAP胰腺病理变化及白介素1、2、6、10表达改变无不利影响。     

Ultrasound guided bilateral rectus sheath block and serum TNF-α and IL-6 after radical prostatectomy: A randomized double blinded study

Background

General anesthesia can affect postoperative cytokine levels, leading to cellular immune inhibition following surgery. The primary objective of this study was to evaluate the effect of bilateral rectus sheath block on serum levels of TNF-α and IL-6 after radical prostatectomy.

Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis

Study ObjectiveTo compare the effects of an intravenous infusion of propofol and the alpha-2 adrenoceptor, dexmedetomidine, on inflammatory responses and intraabdominal pressure (IAP) in severe sepsis after abdominal surgery, specifically, serum cytokine levels (interleukin [IL]-1, IL-6, and tumor necrosis factor [TNF]-α) and IAP.DesignProspective, single-center study.SettingUniversity hospital.Patients40 adult ICU patients who had undergone ileus surgery and who were expected to require postoperative sedation and ventilation.InterventionsPatients received either a loading dose infusion of propofol (Group P; n = 20) one mg/kg over 15 minutes followed by a maintenance dose of one to three mg/kg/hr (n = 20, Group P) or a loading dose of dexmedetomidine of one μg/kg over 10 minutes followed by a maintenance dose of 0.2-2.5 μg/kg/h (n = 20, Group D) at the 24th hour.MeasurementsBiochemical and hemodynamic parameters, cytokine levels, and IAP were recorded before the start of the study and at the 24th and 48th hours.Main ResultsTNF-α levels were significantly lower at the 24th hour (14.66 ± 4.40 pg/mL vs. 21.21 ± 11.37 pg/mL, respectively) and at the 48th hour (21.25 ± 15.85 pg/mL vs. 46.55 ± 35.99 pg/mL, respectively) in Group D. IL-1 levels were significantly lower at the 24th hour (5.03 ± 0.15 pg/mL vs. 6.23 ± 2.09 pg/mL, respectively) and the 48th hour (5.01 ± 0.37 pg/mL vs. 6.42 ± 2.76 pg/mL, respectively) in Group D. IL-6 levels were significantly lower at the 24th hour (253.1 ± 303.6 pg/mL and 511.3 ± 374.8 pg/mL, respectively) and at the 48th hour (343.5 ± 393.4 pg/mL and 503.7 ± 306.4 pg/mL, respectively) in Group D. Intraabdominal pressure also was significantly lower at the 24th hour (12.35 ± 5.84 mmHg vs. 18.1 ± 2.84 mmHg, respectively) and the 48th hour (13.9 ± 6.15 mmHg vs. 18.7 ± 3.46 mmHg, respectively) in Group D.ConclusionDexmedetomidine infusion decreases TNF-a, IL-1, and IL-6 levels and IAP more than a propofol infusion.     

Interleukin-6 and granulocytic elastase levels following laparoscopic cholecystectomy

Interleukin-6 (IL-6) levels have been shown to correlate well with the magnitude of surgical stress. Serum IL-6 and plasma granulocytic elastase levels, 24 h after surgery, were determined in 12 patients who underwent open major surgery [MS group; esophageal carcinoma (n=5), gastric carcinoma (n=3), colorectal carcinoma (n=4) 5 patients who had open cholecystectomy [OC group] and 17 patients who had laparoscopic cholecystectomy [LC group]. IL-6 levels correlated significantly with the duration of surgery (r=0.685,P < 0.01) and with intraoperative blood loss (r=0.583,P < 0.02). However, there was no significant correlation between granulocytic elastase and the duration of surgery or blood loss. Plasma IL-6 levels in the LC group (21±3 pg/ml) were significantly lower than those in the OC group (47±5 pg/ml) and the MS group (186±36pg/ml) (P<0.05;P<0.01). However, there was no significant difference in granulocytic elastase levels between the LC group (318±8g/l), the OC group (360±130 gmg/ml), and the MS group (701±344 g/l). Increased IL-6 levels correlated well with increased duration of surgery. The lower IL-6 levels following laparoscopic cholecystectomy may therefore be indicative of lower surgical stress associated with laparoscopic cholecystectomy.