サイトカインを用いた顎矯正手術における手術侵襲度の評価

Abstract

Surgical duration and hemorrhaging have traditionally been used as indicators of surgical stress. However, recent advances in molecular biology have clarified the roles of various cytokines, and several studies have documented the usefulness of serum cytokine measurement in assessing surgical stress. In the present study, we ascertained the levels of surgical stress by measuring the levels of serum cytokines in patients who underwent bilateral sagittal split ramus osteotomy (BSRO) and those who underwent BSRO and Le Fort I osteotomy (two-jaw surgery: maxillomandibular traction). We also investigated whether serum cytokines could act as useful indicators for surgical stress associated with orthognathic surgery by direct comparison with surgical duration and hemorrhaging.The subjects were seven patients who underwent BSRO (Group 1) and six patients who underwent two-jaw surgery (Group 2) between June 2001 and March 2002. In these patients, serum CRP, surgical duration, and intraoperative hemorrhaging were measured and compared with serum cytokine levels (TNF-α, IL-1β, IL-6, IL-8, IL-10, and IL-12) measured before surgery, immediately after surgery, and at 1, 3 and 7 days after surgery.Surgical duration and hemorrhaging in Group 2 were significantly higher than those in Group 1 (p<0.05). With regard to serum cytokines, levels of IL-6 and IL-10 immediately after surgery for Group 2 were significantly higher than those for Group 1 (p<0.05), but no marked differences were seen at any other measurement points. Levels of IL-1β and IL-12 were often below the detection limits, and as a result, no clear correlation could be found between the two groups. Furthermore, levels of serum IL-6 immediately after surgery showed a strong positive correlation to surgical duration and hemorrhaging (p<0.01).The results of the present study suggest that the levels of serum IL-6 immediately after surgery may be a useful indicator of surgical stress associated with orthognathic surgery, . because levels of serum IL-6 were high immediately after two-jaw surgery.