Effects of Hand Assistant Laparoscopic Splenectomy Plus Pericardial Devascularization on Systemic Stress Responses_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yongshuang ¹ , JIN Junzhe ¹ , LIANGJian ¹ , JIN Hongxu ² , ZHANG Xuefeng ²

1.Department of Emergency Surgery, The Fourth Affiliated Hospital, China Medical University, Shenyang 110032, China;;
2.Department of General Surgery, The General Hospital of Shenyang Military Region, Shenyang 110016, China;

Corresponding author：

Keywords：

Splenectomy; Pericardial devascularization; Laparoscopy; Stress response

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Objective To investigate the effects of hand assistant laporoscopic splenectomy plus pericardial devascularization on systemic stress responses. Methods Forty patients with cirrhotic portal hypertension were selected， 20 cases of which were underwent hand assistant laparoscopic splenectomy plus pericardial devascularization (LAP group)， and the other 20 were underwent open splenectomy plus pericardial devascularization (OP group). The levels of blood glucose （BG）, insulin (Ins), triiodothyronine （T3）, tetraiodothyronine （T4）, corticosteroid （CS） and other related clinical data were measured before operation and on day 1-3 after operation, which were compared between two groups. Results There was no statistical significance between two groups on those levels before operation. On day 1 after operation， BG and CS level in both two groups were higher than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (P gt;0.05), and on day 3 after operation in OP group (P gt;0.05). BG and CS level in OP group were markedly higher than those in LAP group on day 2 after operation (P＜0.05). On day 1 after operation， Ins, T3 and T4 level of two groups were lower than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (P gt;0.05) and on day 3 after operation in OP group (P gt;0.05). Ins, T3 and T4 level in OP group were lower than those in LAP group on day 2 after operation (P＜0.05). There was no significant difference in operation time between two groups (P gt;0.05). But laparoscopic surgery had more advantages than conventional open surgery such as reducing bleeding quantity in operation, shortening recovery time of bowel and urinary bladder function and the length of stay. Conclusion Compared with laparotomy, the laparoscope not only imposes less impact on physical stress system, but also makes recovery after operation more quickly.

Citation： LI Yongshuang,JIN Junzhe,LIANGJian,JIN Hongxu,ZHANG Xuefeng. Effects of Hand Assistant Laparoscopic Splenectomy Plus Pericardial Devascularization on Systemic Stress Responses. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(12): 873-876. doi: Copy

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2.	Brodsky JA, Brody FJ, Walsh RM, et al. Laparoscopic splenectomy: Experience with 100 cases [Ｊ]. Surg Endosc, 2002; 16(5)∶851.
3.	Harris W, Marcaccio M. Incidence of portal vein thrombosis after laparoscopic splenectomy [Ｊ]. Can J Surg, 2005; 48(5)∶352.
4.	陈玉春，张旭. 门静脉高压症56例外科治疗体会 [Ｊ]. 中国普外基础与临床杂志， 2004； 11（1）∶67.
5.	郑璐，李靖，梁平. 腹腔镜脾切除术的研究进展 [Ｊ]. 中国普外基础与临床杂志， 2005； 12（6）∶574.
6.	Borrazzo EC, Daly JM, Morrisey KP, et al. Hand-assisted laparoscopic splenectomy for giant spleens [Ｊ]. Surg Endosc, 2003; 17(6)∶918.
7.	许军，刘昶，王东，等. 手助腹腔镜脾切除联合贲门周围血管离断术在门静脉高压症中的临床应用: 附14例报告 [Ｊ]. 中华肝胆外科杂志， 2007； 13（5）∶311.
8.	胡思安, 周程, 龚昭，等. 腹腔镜与手助腹腔镜脾切除术的临床应用 [Ｊ]. 中国内镜杂志， 2007； 13（3）∶262.
9.	张雪峰，金红旭，李瑾，等. 手助腹腔镜下脾切除门奇断流术(附12例报告) [Ｊ]. 消化外科， 2004； 3（4）∶247.
10.	李索林，左长增，于增文，等. 内结扎法腹腔镜巨脾切除联合选择性贲门周围血管离断术 [Ｊ].中国微创外科杂志， 2007； 7（1）∶20.
11.	Segawa H, Mori K, Kasai K, et al. The role of the phrenic nerves in stress response in upper abdominal surgery [Ｊ]. Anesth Analg, 1996; 82(6)∶1215.
12.	毕涉，高骥援主编. 炎症与抗炎症药 [M]. 第3版. 北京：人民卫生出版社， 1993∶379～380.
13.	Schauer PR, Sirinek KR. The laparoscopic approach reduces the endocrine response to elective cholecystectomy [Ｊ]. Am Surg, 1995; 61(2)∶106.
14.	Soucek M, Kára T. Stress-induced hypertension and diabetes mellitus [Ｊ]. Vnitr Lek, 2001; 47(5)∶315.
15.	裘国花. 应激状态时血甲状腺激素和皮质醇的变化 [Ｊ]. 临床内科杂志， 2003； 20（5）∶233.
16.	李思齐, 白祥军, 王海平，等. 多发伤患者外周血白细胞糖皮质激素受体α、β的表达及其意义 [Ｊ]. 中华创伤杂志， 2005； 21（10）∶729.
17.	Hashiguchi N, Ogura H, Tanaka H, et al. Enhanced expression of heat shock proteins in leukocytes from trauma patients [Ｊ]. J Trauma, 2001; 50(1)∶102.
18.	Rang HP, Urban L. New molecules in analgesia [Ｊ]. Br J Anaesth, 1995; 75(2)∶145.
19.	杨向红, 孙仁华, 徐云祥，等. 危重病患者血清甲状腺素和细胞因子变化的研究 [Ｊ]. 中国急救医学， 2003； 23（1）∶39.
20.	董化锋, 李志伟. 创伤失血性休克患者机体应激反应低下现象分析 [Ｊ]. 内蒙古医学杂志， 2005； 37（4）∶328.
21.	Cuzzocrea S, Riley DP, Caputi AP, et al. Antioxidant therapy: a new pharmacological approach in shock, inflammation, and ischemia/reperfusion injury [Ｊ]. Pharmacol Rev, 2001; 53(1)∶135.

1. Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. Report of a case [Ｊ]. Presse Med, 1991; 20(44)∶2263.
2. Brodsky JA, Brody FJ, Walsh RM, et al. Laparoscopic splenectomy: Experience with 100 cases [Ｊ]. Surg Endosc, 2002; 16(5)∶851.
3. Harris W, Marcaccio M. Incidence of portal vein thrombosis after laparoscopic splenectomy [Ｊ]. Can J Surg, 2005; 48(5)∶352.
4. 陈玉春，张旭. 门静脉高压症56例外科治疗体会 [Ｊ]. 中国普外基础与临床杂志， 2004； 11（1）∶67.
5. 郑璐，李靖，梁平. 腹腔镜脾切除术的研究进展 [Ｊ]. 中国普外基础与临床杂志， 2005； 12（6）∶574.
6. Borrazzo EC, Daly JM, Morrisey KP, et al. Hand-assisted laparoscopic splenectomy for giant spleens [Ｊ]. Surg Endosc, 2003; 17(6)∶918.
7. 许军，刘昶，王东，等. 手助腹腔镜脾切除联合贲门周围血管离断术在门静脉高压症中的临床应用: 附14例报告 [Ｊ]. 中华肝胆外科杂志， 2007； 13（5）∶311.
8. 胡思安, 周程, 龚昭，等. 腹腔镜与手助腹腔镜脾切除术的临床应用 [Ｊ]. 中国内镜杂志， 2007； 13（3）∶262.
9. 张雪峰，金红旭，李瑾，等. 手助腹腔镜下脾切除门奇断流术(附12例报告) [Ｊ]. 消化外科， 2004； 3（4）∶247.
10. 李索林，左长增，于增文，等. 内结扎法腹腔镜巨脾切除联合选择性贲门周围血管离断术 [Ｊ].中国微创外科杂志， 2007； 7（1）∶20.
11. Segawa H, Mori K, Kasai K, et al. The role of the phrenic nerves in stress response in upper abdominal surgery [Ｊ]. Anesth Analg, 1996; 82(6)∶1215.
12. 毕涉，高骥援主编. 炎症与抗炎症药 [M]. 第3版. 北京：人民卫生出版社， 1993∶379～380.
13. Schauer PR, Sirinek KR. The laparoscopic approach reduces the endocrine response to elective cholecystectomy [Ｊ]. Am Surg, 1995; 61(2)∶106.
14. Soucek M, Kára T. Stress-induced hypertension and diabetes mellitus [Ｊ]. Vnitr Lek, 2001; 47(5)∶315.
15. 裘国花. 应激状态时血甲状腺激素和皮质醇的变化 [Ｊ]. 临床内科杂志， 2003； 20（5）∶233.
16. 李思齐, 白祥军, 王海平，等. 多发伤患者外周血白细胞糖皮质激素受体α、β的表达及其意义 [Ｊ]. 中华创伤杂志， 2005； 21（10）∶729.
17. Hashiguchi N, Ogura H, Tanaka H, et al. Enhanced expression of heat shock proteins in leukocytes from trauma patients [Ｊ]. J Trauma, 2001; 50(1)∶102.
18. Rang HP, Urban L. New molecules in analgesia [Ｊ]. Br J Anaesth, 1995; 75(2)∶145.
19. 杨向红, 孙仁华, 徐云祥，等. 危重病患者血清甲状腺素和细胞因子变化的研究 [Ｊ]. 中国急救医学， 2003； 23（1）∶39.
20. 董化锋, 李志伟. 创伤失血性休克患者机体应激反应低下现象分析 [Ｊ]. 内蒙古医学杂志， 2005； 37（4）∶328.
21. Cuzzocrea S, Riley DP, Caputi AP, et al. Antioxidant therapy: a new pharmacological approach in shock, inflammation, and ischemia/reperfusion injury [Ｊ]. Pharmacol Rev, 2001; 53(1)∶135.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effects of Hand Assistant Laparoscopic Splenectomy Plus Pericardial Devascularization on Systemic Stress Responses

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