The effects of abdominal wall-lifting technique, pneumoperitoneum and different anesthesia methods on serum cytokines levels in gynecological patients underwent laparoscopic operation

Abstract

Objective To study the variation of serum interleukin-6 (IL-6),interleukin-10 (IL-10),tumor necrosis factor alpha(TNF-α) and heat shock protein 70(HSP70) in patients underwent gynecological laparoscopic operations using abdominal walllifting(a gasless technique) or pneumoperitoneum methods under different anesthesia.Methods Fifty-seven patients scheduled for gynecological laparoscopy,with operation time less than 100 min,were randomly divided into three groups ( Ⅰ,Ⅱ,Ⅲ ) with 19cases in each group respectively.Group Ⅰ patients were operated with CO2 pneuioperitoneum laparoscopy under general anesthesia.Group Ⅱ patients were operated under general anesthesia and abdominal wall-lifting technique.Group Ⅲ patients went through the same operative procedures as group Ⅱ,but under epidural anesthesia.Serum levels of IL-6,IL-10,TNF-α and HSP70 of all patients were monitored at four points:before anesthesia (Tt),30 min after the establishment of pneumoperitoneum or wall-lifting (T2),10min after it's removal (T3),and at 8 am on the following day (T4).Results There were no significant difference among serum levels of IL-6,IL-10,TNF-α and HSP70 of the three groups at T1(P＞0.05).The serum levels of all these indexes increased after the beginning of the operations,and reaching its peak at T3 in group Ⅰ and peak values at T4 in group Ⅱ and Ⅲ.The level of serum T NF-α[(31±I4) pg/L] was higher in group Ⅰ than that in group Ⅱ [(24±10) pg/L] at T2(P＜0.05).At point T3,serum levels of IL-6[(46±8)pg/L],TNF-α[(54±18) pg/L and HSP70[(3.18±0.58) μg/L] were significantly higher in group Ⅰ than those[ (39±6) pg/L,(36±17) pg/L,(2.30±0.29) μg/L] in group Ⅱ (P＜0.01),and so was the ratio of IL-6/IL-10(P＜0.05 ).Meanwhile,the serum concentrations of IL-6[(27±10) pg/L] and TNF-α [(24±7) pg/L] were significantly lower in group Ⅲ than those in group Ⅱ[ (P＜0.05).Conclusion Gynecological laparoscopic operation using abdominal wall-lifting method can avoid the effect of CO2 pneumoperitoneum and reduce the stress response during operation.Compared to general anesthesia,less stress response was seen in patients under epidural anesthesia. Key words: Anesthesia,general; Anesthesia,epidural; Laparoscopic surgery; CO2 insufflation; Stress