Objective To summarize the research progress of CO2 pneumoperitoneum impacts on invasiveness of cancer cells. Methods Currently published experimental and clinical researches related to the effect of CO2 pneumoperitoneum on invasiveness of cancer cells were reviewed. Results CO2 pneumoperitoneum may affect the invasiveness of cancer cell through several ways， such as changing the structure and function of mesothelial cell， changing microenvironment of peritoneum， influencing the expression of oncogen， affecting the secretion of cell factor， and changing the adhesion of cancer cell. Conclusions The consequences of these alterations to cancer cell and the microenvironment are not well understood， but they may facilitate tumor invasion and implantation. Further investigations in this area are very urgent.
ObjectiveTo explore the feasibility and safety of the artificial pneumoperitoneum and gastrointestinal contrast CT imaging, and imaging diagnostic value on abdominal wall adhesion to intestine after operation. MethodsThirtynine patients with adhesive intestinal obstruction after operation relieved by conservative therapy were included from January 2008 to November 2009. After the artificial pneumoperitoneum established by injection of gas into abdominal cavity and gastrointestinal comparison by oral administration low concentration of meglucamine diatrizoate, CT scan imaging was performed and the radiographic results were compared with surgical findings. ResultsFour patients refused surgery and discharged, so enterolysis was performed in the remaining patients. The surgical findings were consistent with radiographic results. It was showed by laparoscopic operation that intestinal obstruction caused by the fibrous adhesions and the intestine did not adhere to the abdominal wall in eight patients with fibrous adhesion diagnosed by CT. Of eighteen patients with the abdominal wall septally adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed “M”type adhesions and omentum adhesions in sixteen patients underwent open operation, and clear fat space was showed in eight patients and close adhesion was found in another eight patients between the intestine and abdominal wall. Of thirteen patients with the abdominal wall tentiformly adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed continuous and tentiform adhesions and omentum adhesions to the intestine in eleven patients. After the followup of 6-18 months (mean 9 months), incomplete intestinal obstruction occurred in one patient and was relieved by conservative treatment. One patient with discontinuous discomfort in abdomen after operation did not receive any treatment. The other patients were cured. ConclusionThe artificial pneumoperitoneum and gastrointestinal contrast CT imaging can accurately show the location, area, and structure composition of the postoperative abdominal wall adhesion to intestine, which is safety, simple, and bly repeatable, and a better imaging method for the diagnosing of abdominal wall adhesion to intestine after operation.
【摘要】目的 探讨心功能Ⅱ级患者在低气腹压下行腹腔镜胆囊切除术的可能性。 方法 总结我院2003年7月至2004年7月间收治的18例心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术的临床资料。 结果 18例心功能Ⅱ级患者中17例完成腹腔镜胆囊切除，1例中转开腹。 结论 心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术是可行的。
【Abstract】ObjectiveTo investigate the influence of CO2 pneumoperitoneum on intestinal mucosa permeability in rats with liver cirrhosis. MethodsFifty rats were randomly divided into following groups: control group (n=5), cirrhosis group(n=5) and pneumoperitoneum group (n=40); the pneumoperitoneum group was further divided into 8 mm Hg group(n=20) and 13 mm Hg group (n=20). Four time points were chosen, including 0.5, 2, 6, and 12 hours after the end of pneumoperitoneum. After rat models with cirrhosis were established successfully, the abdominal cavity was insufflated with CO2 and maintained under the pressures of 8 mm Hg and 13 mm Hg respectively for two hours. The portal venous blood was collected and the levels of Dlactic acid and endotoxin were measured. ResultsThe levels of endotoxin and Dlactic acid in cirrhosis group were much higher than those of control group（P＜0.05）. The levels of serum endotoxin and Dlactic acid in pneumoperitoneum group were higher than those of cirrhosis group(Plt;0.05) regardless of pressure and time point. The endotoxin level in 13 mm Hg group was higher than that of 8 mm Hg group on different time points (F=5.466, P＜0.05), but there was no difference in Dlactic acid level between both of them（F=0.415,Pgt;0.05）.ConclusionThe intestinal mucosa permeability is increased in rats with liver cirrhosis. It can be further increased under CO2 pneumoperitoneum with certain pressure and time and in a pressuredependent manner. The permeability can decrease after removal of pneumoperitoneum.
【Abstract】ObjectiveTo investigate the effects of CO2 pneumoperitoneum on blood flow of carotid arteries in atherosclerosis rabbits.MethodsFifty Japan white rabbits were randomly divided into control group and three atherosclerosis groups. In atherosclerosis group, the rabbits were randomly subjected to CO2 pneumoperitoneum with an intraabdominal pressure of 0 mm Hg, 10 mm Hg or 15 mm Hg for 2 hours, after the model were created by feeding the rabbits with high fatty diet. The blood flow of the common carotid arteries were measured by electromagnetic blood flowmeter. Artery blood samples were collected for blood gas analysis at 30 minute intervals. ResultsHigher insufflation pressures and longer duration of CO2 pneumoperitoneum were associated with greater increase in blood flow of common carotid arteries. Compared with those in control group and atherosclerosis group with 0 mm Hg CO2 pneumoperitoneum, there were statistically significant increases in blood flow of the common carotid arteries during CO2 pneumoperitoneum in 10 mm Hg and 15 mm Hg pneumoperitoneum group, the changes in 15 mm Hg pneumoperitoneum group were more significant than those in 10 mm Hg pneumoperitoneum group (Plt;0.05). When compared with the blood flow before insufflation, those in 10 mm Hg and 15 mm Hg pneumoperitoneum group also increased significantly during CO2 pneumoperitoneum, even at 30 minute after desufflation (Plt;0.05). However, those in control group and 0 mm Hg pneumoperitoneum group did not change significantly (Pgt;0.05). There were significant decrease in pH and significant increase in PCO2 in both 10 mm Hg and 15 mm Hg groups, when compared with presufflation values or those in control group and 0 mm Hg pneumoperitoneum group(Plt;0.05). The changes in pH and PCO2, however, were no significant at any time point in control group and 0 mm Hg pneumoperitoneum group (Pgt;0.05). HCO3- did not change significantly in either group(Pgt;0.05).ConclusionUnder atherosclerosis conditions, CO2 pneumoperitoneum has an adverse influence on the blood flow of the common carotid arteries which may be associated with increased intrabdominal pressure,absorbed CO2 gas.
Objective To study whether carbon dioxide used to establish pneumoperitoneum has an influence on port-site and intraperitoneal implantation and metastasis of tumor cells. Methods R15 hepatic cancer cells were injected into 30 Wistar rats’ peritoneal cavities 1 hour before operation, then the 30 Wistar rats were randomly divided into 3 groups: gasless group, helium group and carbon dioxide group. The suspension was exposed to the gas environment for 2 hours, all animals were killed after 28 days and the port-site and intraperitoneal implantation and metastasis of tumor cells were examined. Results On port-site, intestinal serous coat, mesentery, greater omentum and diaphragm, the weights of tumor cells, in carbon dioxide group were (326.7±230.3) mg， （626.2±215.9） mg，（476.2±204.8） mg，（2 536.5±906.7） mg and （384.5±149.9） mg respectively； in helium group were (235.6±107.3) mg， （414.2±148.4） mg, （261.8±92.6） mg, （1 633.4±247.3） mg and（220.0±57.9） mg； in gasless group were (145.0±42.4) mg， （221.5±108.2） mg， （212.5±109.6） mg, （797.5±335.9） mg and 113.0 mg.The weights of carbon dioxide group showed a significant increase, compared with helium group and gasless group (P＜0.05). The weights of helium group were greater than gasless group，but there was no significance in statistics (Pgt;0.05). Conclusion The insufflation of carbon dioxide promotes intraperitoneal tumor implantation and growth compared with helium and gaslessness in a rat model.
Objective To investigate the effect of CO2 pneumoperitoneum on the tumor cell port site implantation in laparoscopic surgery. Methods Male SpraqueDawley rats were intraperitoneally injected with gastric cancer cells (cell line SGC-7901). Continuous CO2 pneumo of 15 mm Hg or 30 mm Hg were established for 5 mins, 60 mins, 120 mins and 180 mins with the injection of different concentrations of tumor cells (104/ml, 106/ml respectively). Several samples of peritoneal washing served as positive control. All collecting dishes were incubated at 37℃ with 5% CO2 concentration for one week and then examined for the presence of tumor cell under microscope. Results After one week of incubation, some of the dishes with continuous flow of CO2 gas (5 L/min) at pneumo 30 mm Hg for 60 mins or longer demonstrated tumor growth, and all peritoneal washing samples showed tumor growth, while other dishes showed negative. Conclusion The research suggests that gastric cancer cells can cause port site implantation and the concentration of tumor cells, pneumoperitoneum pressure and duration may affect the occurrence of port site implantation. It may help to find a suitable way to prevent the port site implantation in operations.
Objective To investigate the way of closed establishment of pneumoperitoneum（CEPP） in patients with peritoneal cavity adhesion in laparoscopy, and to sum up the successful experience and the lesson of visceral injury. Methods CEPP experiences of 1 046 cases of peritoneal adhesion were retrospective analysed in 6 600 cases laparoscopy in our unit from September 1991 to September 1999.The difficulty of establishment of pneumoperitoneum was classified as real difficulty in establishment of pneumoperitonum (RDEPP) and false difficulty in establishment of pneumoperitonum (FDEPPD). RDEPP was due to Veress needle penetrating into viscera or peritoneal extensive adhesion in peritoneal cavity, and CO2 air flowing into difficulty. FDEPP was due to veress needle penetrating into extraperitoneum fat, round hepatic ligament or larger messentry. The formal situation required conversion to open laparotomy, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle direction or penetrating depth in second penetration. Results In this group 1 046 patients, 1 028 cases (98.3%) had been established pneumoperitoneum successfully by way of CEPP, 6 cases of RDEPP and 12 cases of FDEPP required open laparotomy. No complication related to CEPP had been found in this group except two cases visceral injury cured by laparotomy and repairment. Conclusion CEPP in patients with peritoneal adhesion is safe and feasible in laparoscopy. The main reason of CEPP failure is regarding FDEPP as RDEPP due to deficiency of experience and confidence of laparoscopist.
目的 评价舒芬太尼复合艾司洛尔对腹腔镜胆囊切除术二氧化碳气腹期间心血管反应和脑电双频指数（BIS）的影响。 方法 2010年1月－2011年12月间，选择美国麻醉医师协会分级Ⅰ～Ⅱ级择期腹腔镜胆囊切除术患者90例，随机分为芬太尼组（A组）、舒芬太尼组(B组）和舒芬太尼+艾司洛尔组（C组）。A组用芬太尼4 μg/kg，B、C组用舒芬太尼0.6 μg/kg麻醉诱导后气管插管，机械通气；C组在气腹前加用艾司洛尔。3组均常规静脉注射咪达唑仑0.1 mg/kg、丙泊酚2 mg/kg和维库溴铵0.1 mg/kg。分别记录各组在气腹前（T1）、气腹30 s（T2）、气腹5 min（T3）、气腹15 min（T4）时的收缩压、舒张压、平均动脉压、心率、血氧饱和度和BIS值。 结果 T1时C组收缩压、舒张压、心率、BIS值最低，各组间差异无统计学意义（P＞0.05）；T2、T3、T4时A组收缩压、舒张压、心率、BIS明显增加，B组有所上升，ⅢC组各时段变化不明显。A组与B组、B组与C组间差异有统计学意义（P＜0.05）。 结论 舒芬太尼复合艾司洛尔能更好地预防腹腔镜胆囊切除术二氧化碳气腹期间心血管反应和抑制BIS的增加。
【摘要】 目的 研究不同压力二氧化碳（CO2）气腹对糖代谢的影响。 方法 18只雌性健康新西兰大白兔按CO2气腹压力随机均分为气腹压0 mm Hg （1 mm Hg=0.133 kPa）（Ⅰ组）、气腹压10 mm Hg（Ⅱ组）和气腹压15 mm Hg（Ⅲ组）。每组兔均在不同的压力下接受气腹1 h。在CO2气腹前（T0）、气腹后30 min （T1）、气腹后60 min （T2） 测定动脉血气分析值、血糖（Glu）、胰岛素（Ins）和胰高糖素（Gln）。 结果 气腹后30 min 、60 min，Ⅱ组与Ⅰ组比较，PaCO2、Glu 、Gln增加（Plt;0.05），pH值和Ins下降（Plt;0.05），Ⅲ组各参数变化更为显著（Plt;0.01）。结论 CO2气腹后机体可能处于较强烈的应激状态，导致血糖升高。【Abstract】 Objective To study effects of different intraabdominal pressure of carbon dioxide (CO2) pneumoperitoneum on blood glucose level in rabbits. Methods Eighteen female healthy rabbits weighed 2.1-3.3 kg were randomly divided into three groups equally based on pneumoperitoneum pressure: 0 mm Hg (1 mm Hg=0.133 kPa) group (groupⅠ),10 mm Hg group (groupⅡ) and 15 mm Hg (groupⅢ). Each group received 1h pneumoperitoneum under diffent pressure. Blood samples were taken before CO2 pneumoperitoneum, at 30 and 60 minutes after pneumoperitoneum for the measure-ments of arterial blood gas, blood glucose (Glu), insulin (Ins) and glucone (Gln). Results After pneumoperitoneum at 30 and 60 minutes, compared with groupⅠ, PaCO2,Glu and Gln were significantly raised in groupⅡ(Plt;0.05), pH and Ins were markedly decreased (Plt;0.05). Even more significant changes were observed in group Ⅲ(Plt;0.01). Conclusion After CO2 pneumoperitoneum, body is in a relatively b stress, so blood glucose is decreased.