摘要
The aim of the study was to evaluate the influence of surgical trauma on systemic inflammation and immune response correlating preoperative and postoperative cytokine levels in patients undergoing laparotomy versus laparoscopic cholecystectomy. Seventy patients with chronic, symptomatic cholelithiasis confirmed by ultrasonography, without presence of cancer or signs of acute cholecystitis were assigned to laparoscopic cholecystectomy-LC （n = 35） and open cholecystectomy-OC （n = 35）. Blood samples were obtained preoperatively, 24 and 72 hours after surgery. Blood concentration of cytokines TNF-ct （tumor necrosis factor-a）, IL-11~ （interleukin-l）, IFN-y （interferon gamma） and IL-6 （interleukin-6）, anti-inflammatory cytokine IL-10 were measured in both groups. Although levels of TNFa were decreased on postoperative day one in LC group, the secretion in patients who underwent open laparatomy was significantly higher （/9 = 0.000）. After 72h the values raised in the OC and also in LC group compared to postoperative day one. Analyzing the values of IFN y and IL-I in our study we noticed that the values declined in the LC group after 72 hours, but significantly raised in the OC group （p = 0.000）. We observed significantly higher values of IL-6 in OC group, with the serum peak level 72 hours after procedure. In contrast, serum levels of IL-6 in patients who underwent laparascopic cholecystectomy had a decrease of values postoperativly. A similar event occurred with IL-10 in the laparoscopic group at the same times.The levels of interleukins are increased and significantly higher in patients undergoing open procedures demonstrating that laparoscopic method displays less inflammatory response compared to open technique.
