Avaliação de proteínas de fase aguda em coelhos submetidos à colecistectomia laparoscópica com dispositivo selante de vasos ou eletrocirúrgico bipolar
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Data
2023-04-11
Autores
Machado, Ana Clara Silva
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Universidade Estadual Paulista (Unesp)
Resumo
As proteínas de fase aguda (PFAs) são utilizadas como marcadores inflamatórios e podem auxiliar no prognóstico pós-cirúrgico. Objetivou-se com o presente estudo, comparar os valores séricos das proteínas de fase aguda e imunoglobulinas de coelhos submetidos a dissecção da vesícula biliar por colecistectomia laparoscópica (CL) utilizando dois diferentes tipos de dissectores (Maryland vs Ligasure), para determinar qual das técnicas apresentou maior grau de inflamação. Vinte coelhos foram distribuídos em dois grupos com dez animais cada, sendo o grupo 1 submetido à técnica de colecistectomia laparoscópica utilizando pinça Maryland (eletrocirúrgico bipolar) para dissecção e dispositivo selante de vasos (DSV LigaSure) para selar o ducto cístico e o grupo 2, submetido à dissecção da vesícula biliar e selagem do ducto cístico utilizando o DSV – LigaSure. As proteínas de fase aguda e imunoglobulinas, foram avaliadas nos dias três, sete e quinze do período pós-operatório. As concentrações séricas de fibrinogênio, transferrina, IgG, α1-glicoproteína ácida, PM 23000 Da e proteína c reativa não apresentaram diferenças significativas entre os grupos 1 e 2, apenas diferenças significativas entre os dias de avaliação no mesmo grupo. IgA, ceruloplasmina e haptoglobina não apresentaram diferenças estatísticas entre grupos e nem entre dias de avaliação. Apenas albumina apresentou diferença entre grupos, onde o grupo 1 demonstrou menor concentração da proteína no D15. Apesar de estudos demonstrarem que o instrumento DSV-LigaSure promove menor dano tecidual que o eletrocirúrgico bipolar (Maryland) e o aumento e diminuição das concentrações de proteínas e imunoglobulinas após a colecistectomia laparoscópica é esperado e transitório, ambas as técnicas apresentaram alterações nas proteínas de fase aguda, demonstrando que não houve superioridade na técnica que utilizou o dispositivo selante de vasos (DSV-LigaSure).
Acute phase proteins (PFAs) are used as inflammatory markers and may help in post-surgical prognosis. The aim of this study was to compare the serum values of acute phase proteins and immunoglobulins in rabbits submitted to gallbladder dissection by laparoscopic cholecystectomy (LC) using two different types of dissectors (Maryland vs. showed a higher degree of inflammation. Twenty rabbits were distributed into two groups of ten animals each, with group 1 submitted to the laparoscopic cholecystectomy technique using Maryland forceps (bipolar electrosurgical) for dissection and vessel sealing device (DSV LigaSure) to seal the cystic duct and group 2, submitted to gallbladder dissection and sealing of the cystic duct using the DSV - LigaSure. Acute phase proteins and immunoglobulins were evaluated on days three, seven and fifteen of the postoperative period. The serum concentrations of fibrinogen, transferrin, IgG, α1-acid glycoprotein, PM 23000 Da and c-reactive protein did not show significant differences between groups 1 and 2, only significant differences between the evaluation days in the same group. IgA, ceruloplasmin and haptoglobin did not show statistical differences between groups or between evaluation days. Only albumin showed difference between groups, where group 1 showed a lower protein concentration on D15. Although studies demonstrate that the DSV-LigaSure instrument promotes less tissue damage than the bipolar electrosurgical instrument (Maryland) and the increase and decrease in protein and immunoglobulin concentrations after laparoscopic cholecystectomy is expected and transient, both techniques showed alterations in phase proteins acute, demonstrating that there was no superiority in the technique that used the vessel sealing device (DSVLigaSure).
Acute phase proteins (PFAs) are used as inflammatory markers and may help in post-surgical prognosis. The aim of this study was to compare the serum values of acute phase proteins and immunoglobulins in rabbits submitted to gallbladder dissection by laparoscopic cholecystectomy (LC) using two different types of dissectors (Maryland vs. showed a higher degree of inflammation. Twenty rabbits were distributed into two groups of ten animals each, with group 1 submitted to the laparoscopic cholecystectomy technique using Maryland forceps (bipolar electrosurgical) for dissection and vessel sealing device (DSV LigaSure) to seal the cystic duct and group 2, submitted to gallbladder dissection and sealing of the cystic duct using the DSV - LigaSure. Acute phase proteins and immunoglobulins were evaluated on days three, seven and fifteen of the postoperative period. The serum concentrations of fibrinogen, transferrin, IgG, α1-acid glycoprotein, PM 23000 Da and c-reactive protein did not show significant differences between groups 1 and 2, only significant differences between the evaluation days in the same group. IgA, ceruloplasmin and haptoglobin did not show statistical differences between groups or between evaluation days. Only albumin showed difference between groups, where group 1 showed a lower protein concentration on D15. Although studies demonstrate that the DSV-LigaSure instrument promotes less tissue damage than the bipolar electrosurgical instrument (Maryland) and the increase and decrease in protein and immunoglobulin concentrations after laparoscopic cholecystectomy is expected and transient, both techniques showed alterations in phase proteins acute, demonstrating that there was no superiority in the technique that used the vessel sealing device (DSVLigaSure).
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Palavras-chave
Dissecção, Inflamação, Videocirurgia, Vesícula biliar