The Effect Of Laparoscopy On The Markers Of Vessel Endothelial Cell Damage And The System Of Blood Coagulation And Fibrinolysis

Objective: To investigate the effect of laparoscopy on the markers of vessel endothelial cell damage and the system of blood coagulation and fibrinolysis. Methods: Ninety-five patients who underwent cholecystectomy from 2004 February to 2004 July were selected as our subjects, among whom 41 cases were male and 54 female, all within the age-bracket 20-40. All the subjects were diagnosed as chronic cholecystitis with gallbladder stone or gallbladder polyps but with the absence of obesity and other concurrent diseases. Among them, 67 cases underwent laparoscopic cholecystectomy (LC) and 28 open cholecystectomy (OC). The LC group were subdivided into LCa (40 cases), in which the operative time was less than 90 minutes, and LCb (27cases), in which the operative time was more than 90 minutes. All LC operations were performed, under general anesthesia, with the same equipment, and no postoperative complication was found. The blood samples of all subjects were collected before operation, and at the point of operation finished (0h) and 24h after operation respectively to study changes of the parameters as follows: (1) the markers of endothelial cell damage, including vWF, TM and ET-1; (2) the markers of blood coagulation such as APTT, PT, TT and FIB; (3) the markers of fibrinolysis such as D-D; (4) the lower extremity venous pressure before and after pneumoperitoneum, as well as after position alteration. The investigation also involved in studying the effect of different operative manners and different LC operative time on these parameters. The experimental data were analyzed by using a statistical software system SAS8.2, Student's t test was applied to studying different lower extremity venous pressure in LC and OC, and analysis of variance were applied to observing both markers' changes of endothelial cells and coagulant function and the effects on the parameters mentioned above at the same time point in LC and OC. Results: (1)The endothelial cell damage markers, vWF,TM and ET-1 increased significantly at postoperative 0h (P<0.05). But vWF and TM still remained higher 24h later than those of preoperative, while ET-1 was decreased to normal level. Furthermore, different subgroups of LC indicated the endothelial cell damage markers were significantly different at postoperative 0h (P<0.05), with parameters in LCb ascending obviously but reducing to insignificance 24h postoperative; (2) In OC cases, the endothelial cell damage markers were increased significantly at postoperative 0h (P<0.05). However, no obvious difference between them was found at postoperative 24h. (3) Lower extremity venous pressure was increased greatly during LG operation and it increased further when we took reverse trendelenburg position. But in the case of OC operation, the changes of lower extremity venous pressure was not significant. Moreover, after pneumoperitoneum and 5 minutes after operation, the changes in LC, compared with OC, were statistically significant (P<0.05). (4) While still staying within the normal scopes, PT was increased significantly (P<0.05) at postoperative 24h both in LC and OC, but the comparison between them indicated that the changes in LC and OC was not significant; APTT and TT only increased slightly, compared with the changes between preoperative and postoperative and among different groups in LC and OC. (5) In both LC and OC, the D-dimer and FIB have significantly increased the momentoperation finished, and more significantly increased 24 hours later. However, no significant difference was found in the comparison between LC and OC and between LCa and LCb at the same time point(P>0.05). Conclusions:(1)Carbon dioxide pneumoperitoneum and the reverse trendelenburg position caused the increase of the lower extremity venous pressure and aggravated the blood stagnation.(2)The endothelial cell damage markers increase higher in LC than those in OC, and the changes become more significant with the increase of operation time. But after operation, the markers decrease faster, with the time processing, in LC than those in...