胸腔手術後之細胞介質與黏滯因子之變化,及FOY對此變化及胸腔手術臨床效果之評估

Abstract

在胸腔手術中，食道摘除加上食道重建手術所引起的術後併發症與死亡率遠大於肺葉切 除手術。本研究在探討食道摘除手術加上食道重建手術是否比肺葉切除手術引起更明顯 的IL-6, IL-8 與ICAM-1 反應。方法:我們收集了6 位食道癌手術與10 位肺葉切除的病 患，以ELISA 測定其血中與胸腔引流液中的IL-6. IL-8 與ICAM-1。 結果:食道癌手術病患術後第一天其血中IL6 明顯地升高，且其變化明顯大於肺葉切除 手術。而第三天之後血中ICAM-1 之升高也明顯大於肺葉切除手術。其差別在第五天更 形明顯。而胸腔局部引流中IL6 與IL8 明顯高於血中IL6 與IL8。(約為血中50-100)倍。 結論:食道手術比起肺葉摘除手術，在早期術後可引起較明顯的IL-6 系統反應，在較晚 期可引起較明顯的ICAM-1 系統反應。二者(IL-6, ICAM-1)可為重大手術所造成的組織 創傷提高一傷害性指標。

Background: In thoracic surgery, esophagectomy combined with esophageal reconstruction has much higher postoperative morbidity and mortality than that of pulmonary lobectomy. IL-6 and IL-8 are important mediators, induced in response to a major trauma or surgery, and closely related to posttraumatic morbidity and mortality. ICAM-1 is the key regulator for the PMN associated cytotoxicity which is the common detrimental pathway for multiple organ failure (MOF). This study was conducted under the hypothesis that, compared to pulmonary lobectomy, esophgectomy combined with esophageal reconstruction surgery can induce more prominent local and systemic IL6, IL8 and ICAM-1 responses, which reflect the intensity of surgical trauma in thoracic surgery. Methods: The level of interleukin-6 (IL-6), interleukin-8 (IL-8) and soluble intercellular adhesion molecule-1 (sICAM-1) in the plasma and pleural drainage were serially examined in 6 patients receiving esophagectomy combined 2 with esophageal reconstruction and 10 with pulmonary lobectomy. Results: In the first postoperative day, patients receiving esophagectomy had significantly higher level of circulating IL6 than those with pulmonary lobectomy (782+391 vs 88+31[pg./ml], p<0.05) . The change of circulating IL8 was comparable between these two groups. The circulating sICAM-1 was significantly higher in esophagectomy group since the postoperative day 5, and the difference between the two groups expanded gradually with time. (774+89 vs 464+95, 845+82 vs 392+68[ng/ml], p<0.05 for postoperative days 5, and 7 respectively) The concentration of IL6 and IL8 in pleural drainage was 50 to 100 times higher than that in plasma. In contrast, the sICAM-1 level in plasma was similar to that of pleural drainage. In the postoperative days 3 and 5 the sICAM-1 level in pleural drainage was significantly correlated with that in plasma.( day 3: p=0.019, R=0.57; day 5: p=0.049, R=0.51) Conclusion: Esophgectomy with esophageal reconstruction surgery, compared to pulmonary lobectomy, can induce a more intensive systemic IL6 response in the early postoperative period and followed by a more obvious elevation of circulating sICAM-1 in the later period. This implies delay endothelial activation following transient cytokine stimulation after extensive surgical trauma by esophgectomy and the vulnerability to remote organ damage in the patients receiving esophgectomy.