Nagelschmidt M, Gerbecks D, Minor T
Second Department of Surgery, Biochemical and Experimental Division, University of Cologne, Ostmerheimer Strasse 200, 51109 Cologne, Germany.
Surg Endosc. 2001 Jun;15(6):585-8. doi: 10.1007/s004640010282. Epub 2001 Mar 13.
The impairment of intestinal perfusion following induction of a pneumoperitoneum may lead to a reduction of peritoneal tissue plasminogen activator (tPA) activity and a concomitant increased risk of adhesion formation.
Pigs were laparotomized to take peritoneal biopsy specimens from the cecum, the ileum, and the abdominal wall. A 15 mmHg pneumoperitoneum was established for 3 h by the insufflation of carbon dioxide (group 2, n = 6) or helium (group 3, n = 6). Group 1 (n = 7) received no gas insufflation. After a 2-h recovery period, additional tissue samples were harvested. Specific tPA activity was then determined in the tissue extracts.
During surgery, specific tPA activity decreased in all the samples. As compared with the control group (100%), this reduction was strongly aggravated in the cecum (-67.6%, p < 0.05) and the ileum (-70.8%) of the CO2 group but only slightly aggravated in the helium group. The parietal peritoneum was not specifically affected by gas insufflation.
The use of a pneumoperitoneum with carbon dioxide significantly affects peritoneal tPA activity and thus may represent a stimulus for adhesion formation.
气腹诱导后肠灌注受损可能导致腹膜组织纤溶酶原激活物(tPA)活性降低,并伴有粘连形成风险增加。
对猪进行剖腹手术,从盲肠、回肠和腹壁获取腹膜活检标本。通过注入二氧化碳(第2组,n = 6)或氦气(第3组,n = 6)建立15 mmHg气腹3小时。第1组(n = 7)未进行气体注入。经过2小时恢复期后,采集额外的组织样本。然后测定组织提取物中的特异性tPA活性。
手术期间,所有样本中的特异性tPA活性均降低。与对照组(100%)相比,二氧化碳组盲肠(-67.6%,p < 0.05)和回肠(-70.8%)的这种降低明显加重,而氦气组仅略有加重。壁层腹膜未受到气体注入的特异性影响。
使用二氧化碳气腹会显著影响腹膜tPA活性,因此可能是粘连形成的一个刺激因素。