| Objective:Due to increased difficulty of surgery,laparoscopic cholecystectomy(LC)for those patients with acute cholecystitis will bring about a series of complications,including bile duct injury,and so on.It remains a subject to be discussed further that how to make a severity assessment and,to choose a suitable treatment modality and timing of surgery.By studying the clinical inflammatory indicators(WBC,CRP)and inflammatory mediators(IL-6,IL-10)perioperatively,combined with postoperative pathology,we try to judge the severity of cholecystitis more accurately by these data,and provide reference for clinical treatment and timing of operation.The perioperative changes on WBC,CRP and IL-6,IL-10 are also discussed.Methods:We chose 16 cases of chronic cholecystitis as control group(Group A),and,over the same period,chose another 60 cases of acute cholecystitis as study group.According to post-operative pathology,we divided them into Group B(acute edematous cholecystitis,21 cases),Group C of(acute suppurative cholecystitis,27 cases)and Group D(acute gangrenous cholecystitis,12 cases).Venous blood samples were taken pre-operatively,24 hours post-operatively,72 hours post-operatively,and 7 days post-operatively(only for study groups),respectively.Centrifugal separated blood specimens were sent to determine WBC、CRP、IL-6 and IL-10.These data were at last summarized and analyzed with SPSS 20.Results:1.WBC:WBC levels were not remarkably changed in control group pre-and post-operatively(P>0.05).In study groups,pre-operative WBC counts were remarkably higher than that of control group(all P<0.05).Among them,there existed a significant difference between group C-B(P<0.05),but not between group C-D(P>0.05).In post-operative 24h,WBC counts in study group showed a slight decline(P>0.05)and a statistically drop in 72h(group C,D,all P<0.05,group A,B,all P>0.05).WBC counts in all groups got to basically normal level till 7 days after operations.2.CRP:CRP level in each study groups were strikingly higher than that of the control group before operations(all P<0.05).Among them,there presented a significant difference between group C-B(P<0.05),but not between group C-D(P>0.05).In post-operative 24h,CRP in all groups manifested a statistically rise(P<0.05),and then dropped in post-operative72h(group A、B,all P>0.05,group C、D,all P<0.05).Till post-operative7d,CRP level is obviously decreased than that of the pre-operative.3.IL-6:IL-6 level in each study groups were significantly higher than that of the control group before operations(all P<0.05).Among them,there was a significant difference between group C-B(P<0.05),but not between group C-D(P>0.05).IL-6 level in study group began obviously decreased(all P<0.05)in post-operative 24h,and went on dropping in post-operative 72h(group A、B,all P>0.05,group C、D,all P<0.05).In post-operative7d,there was no differences existed among each study groups.4.IL-10:Pre-operatively,IL-10 level in study group were remarkably higher than that of control group(all P<0.05).Among them,there was no significant difference between group C-B and group C-D(all P<0.05).IL-10level in study group reduced in post-operative 24h(group B、C,all P>0.05,group D,all P<0.05),and then remarkably raised in post-operative 72h(all P<0.05 in study group,P>0.05 in control group),and went on rising in post-oprative 7d(group B,C,P>0.05,group D,P<0.05).Conclusion:1.Clinical inflammatory indicators(WBC,CRP)and inflammatory mediators(IL-6,IL-10)are compatible in regular pattern and changing tendency among different pathological types of acute cholecystitis.Clinical inflammatory indicators,such as WBC and CRP,can indirectly represent inflammatory mediators,such as IL-6 and IL-10.2.When being acute cholecystitis,WBC、CRP、IL-6 can reflect the severity of acute cholecystitis to some extent.By our data,if WBC>15.29×10~9/L,CRP>126.50 pg/ml,IL-6>47.90 pg/ml,there will be a prediction of moderate acute cholecystitis(Grade II),otherwise,maybe mild acute cholecystitis(Grade I).3.Changes of CRP can reflect the severity of inflammation sensitively.There will be an almost equal increase in CRP regardless of edematous,suppurative,or gangrenous cholecystitis.There will be a obvious rise in patients with moderate acute cholecystitis(Grade II).4.Before operations,the level of proinflammatory factor,IL-6,is mainly depended upon bacterial virulence,and also,relevant to blood flow of gallbladder tissue.When being gangrenous cholecystitis,due to impaired microcirculation in gallbladder tissue,the IL-6 level will be unexpectedly lower than that of suppurative cholecystitis.5.In early post-operative period(24 hours post-operation)of acute cholecystitis,the level of anti-inflammatory factor IL-10,shows first-down-then-up,maybe relevant to uncompleted removal of proinflammatory factors and surgical stress.From 72 hours on after operation,the level of anti-inflammatory factor IL-10 is getting raised,predicting the recovery of inflammation.6.Although descended clinical inflammatory indicators in 7th day after operation,the level of proinflammatory factor IL-6 in study group has not gotten to that of the control group.That means that the recovery of inflammation will be a long process.For inflammation detection,IL-6 is more sensitive than that of WBC and CRP.7.Neither the level of clinical indicators WBC,CRP nor the level of inflammatory mediators IL-6,IL-10,can judge the pathology of the gallbladder(edematous,suppurative or gangrene),although there exists a certain correlation between these indicators and the severity of cholecystitis.The pre-operative severity assessment for acute cholecystitis still depends on a comprehensive judgment,including symptoms,body signs and image results. |
