Bloechle C, Kluth D, Holstein A F, Emmermann A, Strate T, Zornig C, Izbicki J R
Department of General Surgery, University Hospital Eppendorf, University of Hamburg, Martinistrasse 52, 20251 Hamburg, Germany.
Surg Endosc. 1999 Jul;13(7):683-8. doi: 10.1007/s004649901073.
Minimal invasive surgery is increasingly used in conditions complicated by peritonitis-e.g., peptic ulcer perforation. This study was devised to assess the effect of a pneumoperitoneum (PP) on the ultrastructural integrity of parietal peritoneum in perforation-induced peritonitis.
Anesthetized rats were subjected either to standardized gastrotomy simulating gastric perforation (groups Ia-d; IIa-d) or to sham perforation (groups IIIa-d, IVa-d). In group I (a-d) and III (a-d), CO2 was insufflated 12 h after gastrotomy for 60 min (Pia 4 mmHg). Glutaraldehyde was administered intraperitoneally at the end of the PP period while the abdominal wall was still extended (group index a), as well as 30 sec (b), 2 h (c), and 12 h (d) after desufflation. Specimens were taken from the parietal peritoneum of the left diaphragm for scanning electronic-microscopic (SEM) analysis. In groups II (a-d) and IV (a-d), simple puncture of the abdominal cavity was performed, and specimens were taken at corresponding times.
In group Ia (gastric perforation with PP), distortion of the mesothelial cell layer with concomittant opening of stomata to the submesothelial tissue was already observed in specimens harvested while the abdominal wall was still extended. Concomitantly, scarce microvilli, which appeared coarse and thickened, were lying flat on top of the mesothelial cells. After desufflation (groups Ib-c), a rapid process of mesothelial disintegration with disruption from the submesothelial layer and vanishing of microvilli occurred. At 12 h after PP (group Id), complete deterioration of mesothelial cell integrity was observed. In groups IIa-c (gastric perforation without PP), microvilli appeared shrunk and coarse, while integrity of the mesothelial cell layer remained intact up to 2 h after the abdominal puncture. At 12 h after abdominal puncture (group IId), the microvilli had nearly completely vanished and the mesothelium was breaking apart into multiple soils.
In SEM analysis of parietal peritoneum, premature distortion, and disintegration of the mesothelial cell layer was observed in animals exposed to increased abdominal pressure in addition to gastric perforation-induced peritonitis.
微创手术越来越多地用于治疗并发腹膜炎的疾病，如消化性溃疡穿孔。本研究旨在评估气腹（PP）对穿孔性腹膜炎时壁腹膜超微结构完整性的影响。
将麻醉的大鼠进行模拟胃穿孔的标准化胃切开术（Ia-d组；IIa-d组）或假穿孔（IIIa-d组，IVa-d组）。在I组（a-d）和III组（a-d）中，胃切开术后12小时注入二氧化碳60分钟（腹内压4 mmHg）。在气腹期结束时，当腹壁仍伸展时腹腔内注射戊二醛（a组），以及在放气后30秒（b组）、2小时（c组）和12小时（d组）注射。从左膈的壁腹膜取材进行扫描电子显微镜（SEM）分析。在II组（a-d）和IV组（a-d）中，仅进行腹腔简单穿刺，并在相应时间取材。
在Ia组（胃穿孔伴气腹）中，在腹壁仍伸展时取材的标本中已观察到间皮细胞层扭曲，同时气孔向间皮下组织开放。同时，稀疏的微绒毛显得粗糙且增粗，平躺在间皮细胞顶部。放气后（Ib-c组），间皮细胞迅速崩解，从间皮下层脱落，微绒毛消失。气腹后12小时（Id组），观察到间皮细胞完整性完全破坏。在IIa-c组（胃穿孔无气腹）中，微绒毛显得萎缩且粗糙，而间皮细胞层的完整性在腹腔穿刺后2小时内保持完整。腹腔穿刺后12小时（IId组），微绒毛几乎完全消失，间皮细胞分裂成多个碎片。
在壁腹膜的SEM分析中，除胃穿孔性腹膜炎外，暴露于腹腔压力增加的动物中观察到间皮细胞层过早扭曲和崩解。
