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Objective:To evaluate the influence of different CO2 pneumoperitoneum pressure on intestinal mucosal injury and intestinal function recovery in patients undergoing laparoscopic radical gastrectomy.Methods:A total of 120 patients undergoing laparoscopic radical gastrectomy were randomly divided into group A,B and C.Each group included 40 patients.CO2 pneumoperitoneum pressure ingroup A,B and C were 8～10 mmHg,11～13 mmHg and 14～16 mmHg,respectively.The degree of intestinal mucosa damage,plasma D-lactate(2,24 and 48 hours after the treat-ment),intestinal function recovery and complication ration were compared between the three groups.Results:Damage degree of intestinal mucosa after operation in A,B and C groups were 0～1,1～2 and 2～3 respectively.There was significant change in intestinal mucosa injury after operation in both B and C groups.The level of D-lactic acid in group C (2,24 and 48 hours after the treat-ment) were significantly higher those in group A and group B (P＜0.05).The bowel sounds appeared time,exhaust time and intake time in group C were significantly longer than group A and group B (P＜0.05).The incidence of complications were not significantly difference during the three groups.Conclusion:The high pressure of CO2 pneumoperitoneum will cause intestinal mucosa damaged,and not conducive to the patients' intestinal rehabilitation.We suggest that the CO2 pneumoperitoneum pressure should be as low as possible under clear visualization during operation.
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Objective To observe the effect of CO2 pneumoperitoneum combined with position changes on the stability of cardiac electrophysiology in gynecological laparoscopy. Methods The gynecological laparoscopy was performed for 30 patients to undergo elective gynecological laparoscopy under general anesthesia ,with the pneumoperitoneum pressure of 12 mmHg and the Trendelenburg positionat 15° . The observations and analyses were done over the basic monitoring index and the QT interval (QT),T peak tend interval (Tp-e),heart rate corrected QT interval(QTc),QT dispersion(QTd),Tp-e/QT before anesthesia(T0),after anesthesia(T1),1 min after pneumoperitoneum (T2),30 min after pneumoperitoneum and head-down tilt (T3),30 min after deflation and supine position(T4). Results Compared with the time point of T0,QTd increased significantly at T1(P<0.05) and so it was with QT,QTc,QTd,Tp-e,Tp-e/QT at T2,T3,and T4(P<0.05). Compared with the time point of T2,QTc,QTd,Tp-e,Tp-e/QT significantly increased at T3(P < 0.05). Conclusions CO2 pneumoperitoneum combined with Trendelenburg position can prolong ventricular repolarization duration and destroy the stability of cardiac electrophysiology so it may increase the incidence of cardiovascular events.
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Objective To investigate the effects of different ventilation modes on PaCO 2 and PaO 2 during laparoscopic surgery in the Trendelenburg position.Methods Forty cases of laparoscopic resection of rectal cancer were randomly divided into group A (n =20)and group B (n =20).Under general anesthesia,all the cases were in volume-controlled ventilation mode (VCV,tidal volume=10 ml/kg)before pneumoperitoneum.After ventilating in VCV mode for 20 minutes with a lower tidal volume (8 ml/kg),group A was converted to PCV mode for 20 minutes and then back to the VCV mode for 20 minutes again.Next we switched to PCV combined with PEEP (5 cm H 2 O)mode (PCV+PEEP)for 20 minutes.In group B,we only alternated PCV with PCV combined with PEEP.Arte-rial blood-gas analysis was obtained at each time when ventilating mode changed.Results In both group A and B,PaO 2 in VCV mode was less than that in PCV mode and PCV+PEEP mode (P <0.05),PaO 2 in PCV mode was also less than that in mode PCV+PEEP mode (P <0.05).PaCO 2 in PCV and PCV combined with PEEP mode was less than that in VCV mode (P <0.05 ),and there was no difference of PaCO 2 in PCV mode and PCV+PEEP mode.The pH value in VCV mode was less than that in PCV mode and PCV+PEEP mode (P < 0.05).There was no difference in pH value between PCV mode and PCV+PEEP mode.Conclusion PCV combined PEEP mode is beneficial ei-ther in increasing or decreasing of PaCO 2 during laparoscopic surgery in the Trendelenburg position comparing with single VCV mode or PCV mode.
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Gastric cancer is one of the most common gastrointestinal malignant tumor in our country,with the continuous development of minimally invasive surgical technology,laparoscopic radical gastrectomy has gradually been developed,but whether CO2 pneumoperitoneum can cause peritoneal metastasis remains controversial.This article has synthesized the recent reports to illustrate the influence of Heat-CO2 pneumoperitoneum on adhesion molecules,and introduce the latest viewpoint of adhesion molecules affect gastric cancer metastasis.This article can provide clues to evaluate the clinical application value of Heat-CO2 pneumoperitoneum.
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The laparoscopic surgery is increasingly widely used in the treatment of malignant gastrointestinal cancer.Its technical feasibility has been recognized,however,there are disagreements in the evaluation of its safety,the tumor metastasis of port-site and intra-abdominal after operation has been the focus of controversy in medical community.Its major impact mechanism including the change of peritoneal microenvironment,immunity,mechanical pressure of pneumoperitoneum,biological behavior of tumor cells and so on.The specification must be taken before surgery,strictly control the laparoscopic gastrointestinal cancer surgery indications,minimize the pneumoperitoneum pressure,shortem operative time,with He gas instead of CO2 pneumoperitoneum or free pneumoperitoneum laparoscopic techniques and other effective measures to reduce the risk of tumor metastasis.
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ObjectiveTo investigate the lethal effect of hyperthermic CO2 pneumoperitoneum on gastric cancer cells and then further study the feasility and safety of inflating hyperthermic CO2 in gastric cancerpatients when performing laparoscopic operation.MethodsAn in vitro hyperthermic CO2 pneumoperitoneum experimental model was built,then according to the experimental purpose,the stomach carcinoma cell-7901 was grouped:hyperthermic CO2 pneumoperitoneum group; pure hyperthermia group; pure CO2 group;control group.After processing according to groups,cell proliferation was detected by Cell Counting Kit-8(CCK-8),cell apoptosis was detected by Annexin V-fluorescein isothiocyanate/propidium iodide flow cytometry and Hoechst 33342/propidium iodide fluorescent microscopy.ResultsThe reaults of cell proliferation detection showed that hyperthermic CO2 pneumoperitoneum could significantly inhibit proliferation of stomach carcinoma cell-7901 when compared with pure hyperthermia group,pure CO2 group and control group (P ＜ 0.05 ).The results of apoptosis detection showed that hyperthermic CO2 pneumoperitoneum could significantly induce apoptosis of stomach carcinoma cell-7901 and the gastric cancer cells apoptosis showing bright blue under the fluorescent microscope.ConclusionsHyperthermic CO2 pneumoperitoneum could significantly inhibit proliferation of stomach carcinoma cell-7901 and probably kill it by inducing apoptosis.
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Objective To examine the effect of carbon dioxide pneumoperitoneum on local pancreas pathological changes, serum levels of amylase, IL-6, E-selectin and P-selectin in rats with severe acute pancreatitis (SAP). Methods Fifty healthy male SD rats were randomly divided into 3 groups: CO2 experiment group ( n =20): SAP was induced by injecting 5% sodium taurocholate through retrogradely common biliopancreatic ducts via duodenal papilla,and then CO2 pneumoperitoneum was established at a pressure of 12 mmHg for 30 min; SAP group ( n = 20): The rats were treated as same as CO2 experiment group, excepting CO2 pneumoperitoneum; Control group (n = 10): Abdomen was incised and nothing was done to duodenum and pancreas except for moving them softly. The blood samples were gathered for examining serum levels of amylase, IL-6, E-selectin and P-selectin, and histopathologic examination of pancreas was done.Results Compared with control group, the pancreatic pathologic histology score, serum levels of amylase,IL-6, E-selectin and P-selectin were significantly higher in the CO2 experiment group and SAP group (P =0.000). The levels of IL-6 were significantly lower in CO2 experiment group compared to SAP group (P =0. 000). There was no significant difference between CO2 experiment group and SAP group in pancreatic pathologic histology score( P =- 0.294), the levels of serum amylase ( P = 0.073 ), E-selectin and P-selectin. Conclusions CO2 pneumoperitoneum has no adverse effect on the changes of pathological histopathology and the levels of IL-6, E-selectin and P-selectin in SD rats with SAP.
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Objective To investigate the influences of carbon dioxide (CO2) pneumoperitoneum and operation position on intraocular pressure (IOP) during laparoscopic surgery under general anesthesia. Methods Thirty-six patients were divided into two groups of udergoing laparoscopic pelvic surgeries (group A) and udergoing laparoscopic cholecytectomies(group B) with 18 cases each. The patients in group A were operated under 25 degrees head-down position and those in group B under 25 degrees head-up position. IOP was recorded before surgery(T0), at 5 min after tracheal intubation (T1), 5 min after CO2 pneumoperitoneum(T2), 5 min(T3) and 30 min(T4) after body position changed and the time of normal PETCO2 regained(T5). Results IOP was remarkably decreased after induction of general anesthesia in both groups. IOP of group A raised to (21.0±1.6) mm Hg at T4, which was dropped to (14. 6±1.6) mm Hg at T5. IOP of group B raised to (12.1±2.9) mm Hg at T4,which was dropped to (11.1±1.2) mm Hg at T5. Changes of IOP of both groups were positively correlated with the changes of PETCO2. Conclusion IOP can be decreased remarkably after induction of general anesthesia with propofol. The head-up position and normal range of PETCO2 are the two important factors to avoid an increase of IOP in surgical patients under general anesthesia.
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Objective To investigate the effects of CO_2 pneumoperitoneum on the expression of focal adhesion kinase (FAK) of gastric cancer MKN-45 cells. Methods CO_2 pneumoperitoneum with different pressures was simulated in vitro, and the gastric cancer MKN-45 cells were divided into test and control groups. In the test group, gastric cancer MKN-45 cells were cultured in CO_2 pneumoperitoneum with different pressures [5, 10 or 15 mm Hg (1 mm Hg =0.133 kPa)] for 4 hours. The condition of the cells exposed to CO_2 pneumoperitoneum with a pressure of 15 mm Hg was observed at 0.5, 2 and 4 hours. Gastric cancer MKN-45 cells in control group were cultured at normal atmospheric pressure. The expression of FAK and phosphorylated FAK (FAK Tyr397) of each group was detected by Western blot. Multiple-group analysis was done by one-way ANOVA, and intergroup comparison was done by LSD test. Results In CO_2 pneumoperitoneum with pressures of 5, 10, 15 mm Hg, the expression of FAK was 2.14±0.17, 2.07±0.21 and 2.52±0.26, respectively, and the expression of FAK Tyr397 was 1.82±0.28, 1.93±0.52 and 3.71±0.37, respectively. The expression of FAK and FAK Tyr397 in the control group was 2.43±0.46 and 1.71±0.23, respectively. We found significant differences between the 2 groups (F = 2.171, 26.951, P < 0.01). After gastric cancer MKN-45 cells being treated for 0.5, 2 and 4 hours in CO_2 pneumoperitoneum with a pressure of 15 mm Hg, the expression of FAK Tyr397 was 3.41±0.44, 4.12±0.56 and 5.24±0.41 respectively, which is also significantly different (F =116.119, P < 0.01). The expression of FAK Tyr397 was back to 0.72±0.16 1 hour after the release of CO_2. Conclusions CO_2 pneumoperitoneum with different pressures can not promote the expression of FAK in gastric cancer MKN-45 cells which had been cultured for 4 hours, but can activate FAK through promoting its phosphorylation. The degree of FAK phosphorylation increases with pressure and time, and the activity of FAK decreases to pretreatment level rapidly once pressure is released.
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Objective To study the effects of CO2 pneumope ritoneum on the abdominal viscera metastasis and peritoneal implantation of gastric cancer cell line MKN45 during laparoscopic gastric surgery.Methods The gastric cancer cells metastatic model was eslhblished by injecting 1 ml(2×107/ml)human gastric cancer cell line MKN45 susDension into the caecum wall of 60 Balb/C mice.Two weeks later,the Balb/C mice were divided into CO2 pneumoperitoneum group(n=30)and laparotomy group(n=30). All mice were sacrificed 7 weeks later to investigate the abdominal viscera metastasis and peritoneal implantation of gastric cancer cells.Results Twenty-seven rats in CO2 pneumoperitoneum group were induced with tumor,including 8 with troear port implantation and 19 with organ metastasis;26 rats in laparotomy group were induced with tumor,including 7 with tracar port implantation and 19 with abdominal viscera metastasis,and the differences between the two groups had no statistical significance(x2=0.007,0.240,0.202,0.106,0.042,P＞0.05).Conclusions CO2 pneumoperitoneum does not stimulate the metastasis of gastric cancer(cells to peritoneum and abdominal viscera in Balb/C mice.Laparoscopic surgery for gastric cancer is safe and feasible.
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0.05).Conclusions Epidural anesthesia and lower pneumoperitoneum pressure(8 mm Hg) can completely meet with demands of most LC operations,and have the advantages of safety,economy and minimal invasion.
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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 R 15 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). Conclusion The insufflation of carbon dioxide promotes intraperitoneal tumor implantation and growth compared with helium and gaslessness in a rat model.
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Objective To discuss the effect of CO2 artificial pneumoperitoneum on the invasion of the endometrial cancer in nude mouse resulted from the transplantation of the cancer cells and its mechanism.Methods Thirty nude mice were divided into 3 groups based on the time in the CO2 pneumoperitoneum circumstance.Control group: the small intestine of the nude mouse was exposed in air for 5 min,and the cancer cells were injected into right lower quadrant after suture.The gas was depleted after 40 min.40 min group: CO2 gas was poured into abdominal cavity to form a 4 mmHg artificial pneumoperitoneum for 5 min before cancer cells were injected into right lower quadrant.The gas were depleted after 40 min.80 min group: CO2 gas was poured into abdominal cavity to form a 4 mmHg artificial pneumoperitoneum for 5 min before cancer cells were injected into right lower quadrant.The gas were depleted after 80 min.The time that each group took to form a solid tumor was recorded.Four weeks later,the transplantation tumors were taken out and sliced into frozen sections and paraffin-embedded sections.The expression of ?1-intergrin and E-cadherins was detected by IMF.Results The time taken to form the solid cancer was shorter in the 40 min group and 80 min group than in the control group,with more blood vessel found(P0.05).Conclusion The CO2 pneumoperitoneum could enhance the abilities of invasion and adhesion of endometrial cancer cells,which is associated with the expression changes of ?1-intergrin and E-cadherins in the cancer cells.
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BACKGROUND: The wall lift method (W), which was introduced to reduce the adverse effects of CO2 pneumoperitoneum (P), induces an excessive stress response and may be imposed for significant adverse reactions. This study was undertaken to compare the physiologic response of the CO2 pneumoperitoneum and wall lift methods. METHODS: Thirty-two patients were randomly divided into two groups (the P and W). Gastric intramucosal PrCO2, CO2 gap, intramucosal pH (pHi), and plasma concentration of epinephrine and norepinephrine were measured: after the induction of anesthesia, during operation, at the end of the operation, and after operation. Serum concentrations of TNF-alpha and IL-6 were measured at 24 hours before operation, and 24 hours, and 72 hours after operation. The TNF-alpha and IL-6 levels of peritoneal macrophages were also measured. Urine output was measured during operation. RESULTS: PrCO2 and CO2 gap increased during and after the operation in P, and after the operation in W, and pHi decreased during and after operation in P, and after operation in W. Urine output was higher in W. Epinephrine and norepinephrine increased in both groups, but epinephrine was higher in W at the end of the operation. TNF-alpha and IL-6 increased postoperatively and the magnitude of these increases were similar in both groups. The level of TNF-alpha and of IL-6 in peritoneal macrophage were similar in both groups. CONCLUSIONS: We conclude that; CO2 pneumoperitoneum induces intestinal mucosal acidosis, the wall lift method induces more significant stress response, and the magnitude of immune response is similar for both methods.
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Humanos , Acidose , Anestesia , Citocinas , Epinefrina , Concentração de Íons de Hidrogênio , Interleucina-6 , Macrófagos Peritoneais , Norepinefrina , Plasma , Pneumoperitônio , Fator de Necrose Tumoral alfaRESUMO
Objective To examine the effects of carbon dioxide (CO2) pneumoperitoneum on local pancreas pathological changes,serum levels of amylase,IL-1,IL-6,and the positive rate of dissolubility adhesion molecule (CD11a/CD18 and CD11b/CD18) expression in rats with severe acute pancreatitis (SAP). Methods Fifty healthy male Sprague-Dawley (SD) rats were randomly divided into 3 groups:CO2 pneumoperitoneum group (n=20):SAP was induced by injecting 5% sodium taurocholate through retrogradely common biliopancreatic ducts via duodenal papilla,and then CO2 pneumoperitoneum was established at a pressure of 12 mm Hg (1 mm Hg=0.133 kPa) for 30 min; SAP group (n=20):The rats were treated as same as CO2 pneumoperitoneum group,except CO2 pneumoperitoneum; Simple operation group (n=10):Laparotomy was performed and nothing was done to duodenum and pancreas except for moving them softly. The blood samples were collected for examining serum levels of amylase,IL-1,IL-6,and the positive rates of CD11a/CD18 and CD11b/CD18 expression,and histopathologic examination of pancreas was performed. Results Compared with simple operation group,the pancreatic pathologic histology score,serum levels of amylase,IL-1,IL-6,and the positive rates of CD11a/CD18 and CD11b/CD18 expression were significantly higher in CO2 pneumoperitoneum group and SAP group (P=0.000). The levels of IL-1 and IL-6 were significantly lower in CO2 pneumoperitoneum group as compared to SAP group (P=0.000). There was no significant difference between CO2 pneumoperitoneum group and SAP group in pancreatic pathologic histology score (P=0.294),the level of serum amylase (P=0.073),the positive rates of CD11a/CD18 (P=0.155) and CD11b/CD18 expression (P=0.201). Conclusion CO2 pneumoperitoneum has inhibitory effect on the levels of IL-1 and IL-6,rather than the positive rates of CD11a/CD18 and CD11b/CD18 expression in SD rats with SAP.
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Objective To investigate the effects of CO 2 pneumoperitoneum on circulation, P ET CO 2 and blood gas during laparoscopic hepatectomy. Methods Fourteen patients underwent laparoscopic hepatectomy with CO 2 pneumoperitoneum. The MAP, HR, CVP, P ET CO 2 , airway pressure and blood gas were monitored respectively before, 30min, 60min, 120min after pneumoperitoneum, and 10min and 30min after deflation of the abdomen. Results The HR, P ET CO 2 , PaCO 2 , and plood K + were significantly higher 30min after pneumoperitoneum compared with the values before pneumoperitoneum (P
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Objective To evaluate the effect of CO2 pneumoperitoneum with various pressures on the ultrastructure of the implanted lesions in rats model of endometriosis. Methods Endometriosis model was established in 30 SD rats by implanting self-endometria onto the peritoneum to form ectopic endometrial tissues. Then the animals were divided randomly into three groups (ten in each):control,10 mm Hg,and 20 mm Hg CO2 pneumoperitoneum groups (CO2 inflation lasted for 1 hour). One week after the procedure,the ectopic endometrial tissues were sampled for electron microscopy to determine the ultrastructure of cell organelle in the endometriosis glands and matrix cells. Results The electron microscopy showed that in the control group,the matrix cells lined up in order and the structure of the microvilli (MV) was normal; while in the 10 mm Hg and 20 mm Hg groups,the chromatin margination of glandular cells and mitochondria swelling were observed with reduced or vanished mitochondrial crista,the ultrastructural damages to the microvilli (reduced or vanished) were more apparent than the control,the cell junctions were widened or collapsed,and the matrix cells lined up disorderly. Compared to the 10 mm Hg group,ultrastructural damage to the glandular cells in the 20 mm Hg group was more severe. Conclusions CO2 pneumoperitoneum intervention can induce ultrastructural damage to endometriosis lesions. 20 mm Hg pressure of CO2 pneumoperitoneum can induce severer damage to the ectopic endometriosis tissues than 10 mm Hg.
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Objective To investigate the influence of different types of pneumoperitoneum on the ultrastructure of the extraperitoneal muscular tissues in rats. Methods By using pulse-mode or constant-pressure mode insufflators,we established CO2 pneumoperitoneum in 80 rats (40 for each) with the pressure set at 15 mmHg. At 60,90,120 and 180 minutes after the insufflation,the muscular tissues below the peritoneum of the rats (10 rats at each time point) were obtained to observe the ultrastructural change under a transmission electron microscope (TEM). Ten rats that received anesthesia only were set as a control. Results In both the groups,vacuolar degeneration was found in the myocytes below the peritoneum after 60 minutes of pneumoperitoneum,and became more and more marked with time. Moreover,the phenomenon was more significant in the pulse-mode insufflator group,in which,we observed widened gaps and vacuoles among the myocytes at 180 minutes after the insufflation,while in the other group,such changes were not apparently detected. Conclusions CO2 pneumoperitoneum may injure the muscular tissues below the peritoneum in rats. Constant-pressure mode insufflator is helpful to decrease such an injury.
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Objective To study the influence of intraperitoneal instillation of arsenic trioxide (As_2O_3) on metastasis of hepatoma cell line H_22 under CO_2 pneumoperitoneum in mice. Methods The experiment included 40 Kunming mice (cleaning inbred strain). A 1 mm trocar was punctured through the middle abdomen, by which 1?106 tumor cells were administered. Pneumoperitoneum was established with carbon dioxide at the pressure of 8 mm Hg over 30 min. Afterwards, the mice were randomly divided into four groups with 10 mice in each group, receiving intraperitoneal instillation with one of the following: normal saline (1 ml), As_2O_3 (2 mg/kg, 1 ml), As_2O_3 (4 mg/kg, 1 ml), or As_2O_3 (4 mg/kg) with heparin (10 U/ml) (1 ml totally). Levels of CD_44 and vascular endothelial growth factor (VEGF) were measured on the 3rd and 7th day after pneumoperitoneum, respectively. And the survival condition, abdominal circumference, body weight, and diameter of metastatic tumor were compared among the four groups.Results Compared with control group, significantly lower expressions of CD_44 and VEGF were observed the other three groups on the 3rd and 7th day after pneumoperitoneum (P