RESUMO
The effects of surgical trauma resulting from laparoscopic cholecystectomy and open cholecystectomy, were compared by assessing the postoperative acute phase alterations of selected plasma proteins, hormones and lymphocyte subpopulations in fifty-seven patients prior to elective cholecystectomy. Patients were prospectively randomized to undergo either laparoscopic cholecystectomy (n = 30) or open cholecystectomy (n = 27). Duration of operation and general anesthesia was similar in the two patient groups. The laparoscopic cholecystectomy patients had a shorter postoperative stay in hospital (3.1 (0.5) days vs. 7.1 (1.6) days; p < 0.001). In open cholecystectomy patients a significantly greater postoperative acute phase increase in plasma C-reactive protein (p < 0.001), cortisol (p < 0.05), and prolactin blood level (p < 0.001) was recorded. The postoperative acute phase decrease in the blood total-T-lymphocyte count (CD3 cells) and in the activated-lymphocyte count (OKDR cells) was significantly greater after open cholecystectomy (p < 0.05). These results, showing that acute phase responses are less marked after laparoscopic cholecystectomy than after open cholecystectomy, support the concept that the laparoscopic procedure is less traumatic.
Assuntos
Reação de Fase Aguda/sangue , Proteína C-Reativa/análise , Colecistectomia , Colelitíase/cirurgia , Hidrocortisona/sangue , Orosomucoide/análise , Prolactina/sangue , Subpopulações de Linfócitos T/metabolismo , Linfócitos T/metabolismo , Adulto , Biomarcadores/sangue , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD8-Positivos/metabolismo , Colecistectomia Laparoscópica , Feminino , Humanos , Tempo de Internação , Ativação Linfocitária , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Prospectivos , Resultado do TratamentoRESUMO
Fourteen cases of primary gastric non-Hodgkin malignant lymphoma have been classified according to the "Working Formulation for Clinical Usage" and according to the Kiel classification. They have been staged according to the Ann Arbor staging system modified by Musshoff and according to the Manchester staging system modified by Rao. They have been also arranged in the Friedman's macroscopic types. Clinical features, radiologic and endoscopic findings, performed surgical operations, histologic reports and prognostic factors are reported and discussed. The patients, after surgery, have been treated with radiotherapy and/or polychemotherapy, according to the suggested therapeutic pattern. The follow-up has evidenced a better prognosis than gastric carcinoma. The importance of the preoperative diagnosis is emphasized. This is often difficult to obtain, but it permits a better surgical treatment and especially the right intraoperative staging.