Effect Of Differents Operative Time Of Laparoscopic Cholecystectomy On Systemic Stress And Immune Response

BackgroundSurgical injury is a special trauma. Operation , which includes stimulation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, can induce a systemic endorcrine-metabolic response and immunosuppresion. These response is proportional to the severity of surgical stress. The operative time and skin incision are the important to affect the severity of surgical stress. Laparoscopic opertion is micro-trauma surgical opration, which indues smaller skin incision and slight surgical stress. But, can shorten the operative time significanty reduces the stess response? Up to now , this research is few. Materials and methods ObjectsIn a randomized clinical trial of 60 patients undergong Laparoscopic cholecystectomy, which were divided to threes groups which comply with operative time: A group (<30 min, 20 cases);B group (31-60 min, 20 cases) ; C (>60 min ;20 cases). Pre-operative general examinations were normal. All patients undergonggeneral anesthesia and four-pore Laparoscopic cholecystectomy, the press of CO2 is1.9kPa.MethodPost-operative pain and body temperature in first day were compared within groups. And the stess and immune response are compared within groups. CRP?IL-6. ACTH> cortisoK blood sugar were measured before > at end and at 6 ^ 24 h after operation. CD3x CD4, CD8x CD4/CD8 and Nkcell were measured before , and at 6^ 24 h after operation. C3 > C4, IgG> IgM> IgA were measured before and 24 h after operation. ResultBody temperatur was no significanty differences between groups. Postoperative pain was significanty differences (p<0.05).Plasma levels of IL-6 > CRP were significanty increased after LC , IL-6 peak at 6 h after operation and CRP peak at 24 h after LC. Plasma levels of CRP were significanty differences between A and CN B group. Plasma levels of IL-6 were significanty differences between A and C group.Plasma levels of ACTHU cortisol were significanty increased after LC (p<0.01) , cortisol peak at 6 h after operation and ACTH peak at end of operation . Plasma levels of ACTH were significanty differences between A and C> B group (p<0.01). Plasma levels of cortisol were significanty differences between A and C groupBlood sugar were increased after LC , peak at 6 h after operation. Blood sugar were significanty differences between A and C^ B group (p<0.05).CDS N CD4 were significanty decreased after LC each group (p<0.0 1) , peak at 6h after operation. And significanty differences between A and Cx B group (p<0.01) . CDS were significanty decreased within IK C groups, at 6 h after operation (p<0.05). CD4/CD8 were significanty decreased within B> C groups, at 6 IK 24 h after operation (p<0.01), were significanty differences between A and C group (p<0.05). NK cell were significanty decreased within E^ C groups, at 24 h after operation (p<0.05), were significanty differences between A and C group (p<0.05). In A group ,CD4/CD8 x CDS and NK cell were no significanty decreased after operation .Serum level of IgG was were significanty decreased after LC each group (p<0.05),serum level of IgA^ IgM was were significanty decreased after LC in B^ C group (p<0.05), were no significanty differences between A and C group ,except for IgG . Serum level of C3 was were significanty decreased after LC in B, C group (p<0.05), were significanty differences between A and C group (p<0.05). Serum level of C4 was only were significanty decreased after LC in C group (p<0.05), and were no significanty decreased each groups. ConclusionThe systemic stress response and the immunosupression were enhanced after prolonging operative time of Laparoscopic cholecystectomy.