Systemic Stress Responses After Laparoscopic And Laparostomy Cholecystectomy: Variety Of Et And Sod

Objective:To study the effect of laparoscopy on stress in patients. Methods:One hundred and seventy-eight patients were selected to undergo laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) from 2007 September to 2008 September in department of hepatobiliary of PLA 474 hospital. All cases were chronic cholecystitis,71 of them were male,107 cases were female. The age range was 18-84 years (average 49.9±3.5 years), there were 89 cases (50%) in elder-age (≥60years):and 89 cases in younger-age group (<60years). Diseases were gallbladder stone (122 cases, 68.54%) and gallbladder polyps (56 cases,31.46%).139 cases underwent LC, the others were operated using the open technique. Patients underwent LC were divided into 3 groups,26 cases belong to group A (operative time was less than 30 min.),76 cases belong to group B (operative time was from 30 to 60 min.),37 cases belong to group C (operative time exceed 60 min.). All LC were performed under same equipments and conditions. Each operation was performed by general anaesthesia. There were no serious complications. All patients'blood was sampled to measure stress markers ET, SOD before operation(TO), after operation(Tl), the 1st,2nd,3rd and 5th morning. We observed the change of stress marker before and after operation, the effect of stress caused by LC and OC, the effect of stress caused by sex, age, disease, operative methods and operative time of LC. We compared the stress markers between pre- and post-operation of LC, LC and OC, between A, B and C groups of LC. We also compared the effect of stress caused by sex, age, disease and operative time. SPSS 16.0 statistical software was used to analysis these data. Results:1) ET:No statistical significant deference between the two groups on TO's ET level was found. ET level of T1 of both groups was lower than TO's, but there was no significant deference; ET level of LC group of 1st and 2nd day postoperation was significantly lower than TO's (P<0.05), which restored to T0's level in the 3rd day postoperation. ET level of OC group raised in 1st day postoperation and restored to TO's. ET level of 1 st and 2nd day postoperation of OC group was significant higher than that of LC group's.2) SOD:T1's SOD level of both groups was significant lower than T0's (P< 0.01,P<0.05);SOD level of LC group of 1st day postoperation raised faintly,but was still lower than TO's level, which restored to TO's level in 2nd day postoperation; SOD level of OC group of 1st and 2nd day postoperation were significant lower than TO's level, which restored to TO's level in 3rd day postoperation. SOD level of 2nd day postoperation of LC group was significant higher than which of OC group's.3) There was no significant difference in age, sex or disease by analysis of variance.4) The markers of stress in different groups divided by operative time of LC were no significantly difference (P> 0.05) by analysis of variance. Conclusions:1) The operative methods was the key factor in all factors effecting stress responses. The stress responses after LC were significantly reduced when compared with those after OC.2) There was no significant difference in effect of age, sex or disease on stress responses after LC.3) According to laparoscopic cholecystectomy, operative time effect stress responses faintly under same anaesthesia methods.