摘要
选择20例胆囊结石患者分别行腹腔镜和开腹胆囊切除术各10例。于术前、手术结束时和术后1、3、5天取血测定及观察与刨伤有关激素的动态变化并进行比较。结果显示两组术后的激素水平均较术前升高,但升高的幅度和持续的时间各有区别。其中:(1)肾上腺素、去甲肾上腺素和生长激素均于手术结束时达高峰值,并明显高于术前水平(三者均 P<0.05);开腹组虽高于腹腔镜组,但其差别尚不显著(P>0.05);(2)术后两组皮质醇值也有上升,在第1天便达到最高水平;胰岛素值于手术结束时较术前略有下降,也在术后1天达峰值,但与术前相比无显著性差异。两组各激素的恢复时间亦有不同。腹腔镜组肾上腺素、去甲肾上腺素和生长激素于术后第1天,皮质醇、胰岛素则在术后第3天恢复至术前水平。开腹组肾上腺素、生长激素于术后3天,皮质醇于术后5天才恢复术前水平,去甲肾上腺素和胰岛素于术后5天仍高于术前水平。观察表明,腹腔镜和开腹胆囊切除术均可引起明显的创伤应激反应。虽然两组间各种激素变化在术后各个时期比较无显著性差异,但开腹组激素变化较腹腔镜组明显,且持续时间长,似可说明开腹手术的创伤反应较腹腔镜手术更加明显。
Five serum traumatic related hormones as: epinephrine (EP),norepinephrine (NE),growth hormone (GH),cortisol(CS)and insulin(IS) were determined and compared dynamically on the day before surgery,by the end of operation as well as on the 1st,3rd,and 5th post- operative days in two groups of 10 patients each with gallstones treated either by laparoscopic (LC) or open cholecystectomy (OC).The results showed that (1) The concentrations of EP,NE and GH were significant (P< 0.05) elevated by the end of surgery in both groups when comparing with their preoperative values.The lev- els of these 3 hormones in OC group were much higher than that of LC group but the difference did not reach statistical point (P>0.05).(2) Serum content of CS and IS in both groups also increased and reached their peak values on the 1st day after surgery,hut the comparison of either inside group pre-and postoperatively or between two groups were all failed to show any statistical signifi- cance.(3) The recovery time for each elevated hormone were various one from another.In general,increased lev- els of ①EP,NE and GH;②CS and IS in LC group re- turned to baseline on 1st and 3th postoperative day re- spectively,while in OC group,①EP and GH;②CS did not returned to preoperative level until the 3 and 5th postoperative day respectively,and NE were still higher than basal levels even on the 5th day after surgery.In conclusion:both LC and OC can lead to obvious traumat- ic stress with significant elevation of norepinephrine ob- served.Although no statistical difference exists in other hormones between two groups,the magnitude and the duration were greater in OC group,which suggest that the traumatic response caused by OC seem to be more se- vere than that by LC.
出处
《普外临床》
CSCD
1995年第5期261-263,273,共4页
