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目的研究行悬吊式与气腹腹腔镜手术病人术中血皮质醇、白介素-6(IL-6)、白介素-10(IL-10)和肿瘤坏死因子-α(TNF-α)浓度的变化。方法选择2005年7月至2006年2月于南京医科大学第一附属医院择期行腹腔镜下卵巢肿瘤切除术的病人38例,随机分成两组,每组19例,手术时间均<100min。Ⅰ组,于静脉全麻下行CO2气体腹腔镜手术;Ⅱ组,于静脉全麻下行悬吊式腹腔镜手术。监测两组患者麻醉前(T1)、气腹或悬吊建立后30min(T2)、气腹或悬吊撤除后10min(T3)和术后次日晨8时(T4)4个时点的血皮质醇、IL-6、IL-10和TNF-α的浓度。结果麻醉前两组患者的血皮质醇、IL-6、IL-10和TNF-α差异无统计学意义(P>0.05)。术后各指标均升高,其中Ⅰ组在T3时达峰值,Ⅱ组在T4时达峰值。组间比较,Ⅰ组在T2时点的血皮质醇[(493.3±77.3)pg/L]和TNF-α[(31.4±13.7)pg/L]高于Ⅱ组[(422.9±75.6)pg/L,(24.2±9.8)pg/L](P<0.05);在T3时点,Ⅰ组的血皮质醇、TNF-α和IL-6均显著高于Ⅱ组,且Ⅰ组的IL-6/IL-10比值也高于Ⅱ组。结论悬吊式腹腔镜技术免除了CO2气腹对机体的影响,降低了术中应激反应水平。
Objective To study the changes of plasma cortisol, interleukin-6 (IL-6), interleukin-10 (IL-10) and tumor necrosis factor-α (TNF- α) in patients undergoing laparoscopic and pneumoperitoneal laparoscopic surgery . Methods From July 2005 to February 2006, 38 patients undergoing laparoscopic ovarian tumor resection in the First Affiliated Hospital of Nanjing Medical University were randomly divided into two groups (n = 19 in each group). The operation time was <100min. Group Ⅰ, underwent CO2 gas laparoscopic surgery under general anesthesia; Group Ⅱ, underwent laparoscopic surgery under general anesthesia. Blood samples were collected before anesthesia (T1), 30 min after pneumoperitoneum or suspension was established (T2), 10 min after pneumoperitoneum or suspension removal (T3), and 8 after surgery (T4) Cortisol, IL-6, IL-10 and TNF-α concentrations. Results There was no significant difference in serum cortisol, IL-6, IL-10 and TNF-α between the two groups before anesthesia (P> 0.05). All indexes increased after operation, in which group Ⅰ reached the peak at T3 and reached the peak at T4. The levels of serum Cortisol (493.3 ± 77.3) pg / L and TNF-α in group Ⅰ at T2 were significantly higher than those in group Ⅱ [(422.9 ± 75.6) pg / L, (24.2 ± 9.8) pg / L] (P <0.05). At T3, the levels of Cortisol, TNF-α and IL-6 in group Ⅰ were significantly higher than those in group Ⅱ / IL-10 ratio is also higher than Ⅱ group. Conclusions Suspension laparoscopy can avoid the influence of pneumoperitoneum on the body and reduce the intraoperative stress response.