| Abstract | CILJ ISTRAŽIVANJA: Razvoj novih tehnika minimalno invazivne kirurgije poput NOTES i hibridnih NOTES zahvata dodatno smanjuje traumu i ozljedu tkiva jer se za ulazak u tjelesne prostore koriste prirodni tjelesni otvori. Cilj ovog istraživanja je usporediti razinu stresnog odgovora u laparoskopskoj kolecistektomiji s pomoću triju troakara i laparoskopski asistiranoj transvaginalnoj kolecistektomiji mjerenjem razine upalnih parametara: interleukina-6 (IL-6), C-reaktivnog proteina (CRP) i leukocita (L).
ISPITANICI I METODE: Ovo je prospektivna, longitudinalna, kontrolirana studija u koju su uključene pacijentice operirane u Klinici za abdominalnu kirurgiju KBC-a Split u razdoblju od prosinca 2013. godine do studenog 2015. godine. U studiji je analizirano 30 pacijentica: 18 pacijentica kod kojih je učinjena laparoskopska kolecistektomija s pomoću triju troakara - skupina LP, i 12 pacijentica kod kojih je učinjena laparoskopski asistirana transvaginalna kolecistektomija - skupina TV. Pacijenticama u obe skupine su mjerene serumske koncentracije interleukina-6 (IL-6), C-reaktivnog proteina (CRP) i leukocita (L) u 3 vremenska intervala: 24 sata prije operacije, 24 sata nakon i 48 sati nakon operacije.
REZULTATI: Dobiveni su rezultati u kojima nije bilo značajne razlike u serumskim koncentracijama upalnih parametara IL-6, CRP i L između skupina LP i TV u nijednom vremenskom intervalu u kojemu su mjerene.
Koncentracija IL-6 u serumu je iznosila 60,94±125,00 pg/mL u skupini LP i 13,91±15,65 pg/mL u skupini TV 24 sata nakon operacije (p=0,16) te 13,50±12,66 pg/mL u skupini LP i 6,52±4,30 pg/mL u skupini TV 48 sata nakon operacije (p=0,20).
Koncentracija CRP-a u serumu bila je 23,19±28,67mg/L u skupini LP i 20,37±32,97 mg/L u skupini TV 24 sata nakon operacije (p=0,82) te 49,56±61,72 mg/L u skupini LP i 28,68±44,84 mg/L u skupini TV 48 sata nakon operacije (p=0,21).
Broj leukocita u serumu je iznosio 9,45±3,15 x 109/L u skupini LP i 9,38±2,25 x 109/L u skupini TV 24 sata nakon operacije (p=0,23) te 7,48±2,52 x 109/L u skupini LP i 7,19±1,84 x 109/L u skupini TV 48 sata nakon operacije (p=0,60).
ZAKLJUČAK: Naše istraživanje je pokazalo da su razine upalnih parametara interleukina-6 i C-reaktivnog proteina kao i broj leukocita niži u laparoskopski asistiranoj transvaginalnoj kolecistektomiji u odnosu na laparoskopsku kolecistektomiju s pomoću triju troakara, ali bez statističke značajnosti. |
| Abstract (english) | OBJECTIVE: The development of new techniques of minimal invasive surgery such as NOTES and hybrid NOTES even more reduces trauma and tissue injury. The aim of this study is to compare the stress response in three-port laparoscopic cholecystectomy with laparoscopic assisted transvaginal cholecystectomy by measuring levels of inflammatory parameters: interleukin-6 (IL-6), C-reactive protein (CRP) and leukocyte (L).
PATIENTS AND METHODS: This is a prospective, longitudinal, controlled study that includes patients operated in the Department of Abdominal Surgery KBC Split in the period from December 2013 to November 2015. The study analyzed 30 patients: 18 patients underwent three-port laparoscopic cholecystectomy - group LP and 12 patients underwent laparoscopic assisted transvaginal cholecystectomy - group TV. Interleukin-6 (IL-6), C-reactive protein (CRP) and leukocyte (L) were measured in all patients 24 hours prior to surgery, 24 hours after and 48 hours after surgery.
RESULTS: No significant differences in serum inflammatory parameters of IL-6, CRP and L was found between groups LP and TV in any period of time in which they were measured.
The concentration of IL-6 in serum was 60.94 ± 125.00 pg / mL in group LP and 13.91 ± 15.65 pg / mL in group TV 24 hours after surgery (p = 0.16) and 13.50 ± 12.66 pg / mL in group LP and 6.52 ± 4.30 pg / mL in group TV 48 hours after surgery (p = 0.20).
The concentration of CRP in serum was 23.19 ± 28.67mg / L in Group LP and 20.37 ± 32.97 mg / L in the group TV 24 hours after surgery (p = 0.82), and 49.56 ± 61.72 mg / L in group LP and 28.68 ± 44.84 mg / L in the group TV 48 hours after surgery (p = 0.21).
The leukocyte count in serum was 9.45 ± 3.15 x 109/L in group LP and 9.38 ± 2.25 x 109/L in the group TV 24 hours after surgery (p = 0.23) and 7.48 ± 2.52 x 109/L in group LP and 7.19 ± 1.84 x 109/L in a group of TV 48 hours after surgery (p = 0.60).
CONCLUSION: Our study has shown that levels of inflammatory parameters interleukin-6 and C-reactive protein and leukocyte count were lower in laparoscopic assisted transvaginal cholecystectomy compared to three-port laparoscopic cholecystectomy, but without statistical significance. |
