Are C, Talamini M A, Murata K, De Maio A
Department of Surgery, The Johns Hopkins Medical Institutions, Blalock 665, 600 North Wolfe Street, Baltimore, MD 21205, USA.
Surg Endosc. 2002 Oct;16(10):1464-7. doi: 10.1007/s00464-001-8305-5. Epub 2002 Jun 4.
As laparoscopic surgery continues to expand in scope, septic patients will be exposed to carbon dioxide (CO2) pneumoperitoneum in increasing numbers. The biologic advantages or disadvantages of laparoscopic surgery in the setting of sepsis/inflammation are not known. In a rat model, we investigated whether CO2 pneumoperitoneum alters the inflammatory response induced by bacterial lipopolysaccharide (LPS).
Male rats were injected via the penile vein with LPS (1 mg/kg). Five hours later, the animals (n = 5) were subjected to CO2 pneumoperitoneum (group I) for 1h; the animals of group II (n = 5) served as controls (no pneumoperitoneum). At 6 h, all animals were killed and the liver harvested for analysis of hepatic acute-phase gene expression. Total RNA was isolated and analyzed by Northern blot hybridization with probes for alpha-2 macroglobulin (A2M) and detected by autoradiography. The film in the linear range of exposure was quantitated using an imaging system. The signal intensity corresponding to A2M mRNA was normalized by the signal corresponding to 28S rRNA detected by staining with methylene blue.
The mRNA levels in group II was 6.5 +/- 0.9 vs 2.8 +/- 0.4 in group I. As compared with rats that received LPS only, those that received a combination of LPS and CO2 showed a reduction in A2M mRNA levels (57.4%, p = 0.006).
These data demonstrate that the presence of CO2 pneumoperitoneum reduces the inflammatory response established by LPS. This finding challenges the generally accepted notion that smaller incisions alone account for the observed benefits of laparoscopic surgery. It further suggests that CO2 pneumoperitoneum - aided laparoscopic surgery impedes the inflammatory response and may therefore offer specific benefits over conventional surgery.
随着腹腔镜手术范围不断扩大，越来越多的脓毒症患者将接受二氧化碳（CO₂）气腹手术。目前尚不清楚腹腔镜手术在脓毒症/炎症情况下的生物学利弊。在大鼠模型中，我们研究了CO₂气腹是否会改变细菌脂多糖（LPS）诱导的炎症反应。
通过阴茎静脉给雄性大鼠注射LPS（1mg/kg）。5小时后，对动物（n = 5）进行1小时的CO₂气腹（I组）；II组动物（n = 5）作为对照（无气腹）。6小时时，处死所有动物并摘取肝脏，分析肝脏急性期基因表达。分离总RNA，用α-2巨球蛋白（A2M）探针进行Northern印迹杂交分析，并通过放射自显影检测。使用成像系统对曝光线性范围内的胶片进行定量。用亚甲蓝染色检测的28S rRNA对应的信号对A2M mRNA对应的信号强度进行标准化。
II组的mRNA水平为6.5±0.9，而I组为2.8±0.4。与仅接受LPS的大鼠相比，接受LPS和CO₂联合处理的大鼠A2M mRNA水平降低（57.4%，p = 0.006）。
这些数据表明，CO₂气腹的存在会降低LPS引发的炎症反应。这一发现挑战了普遍接受的观点，即仅小切口就能解释腹腔镜手术所观察到的益处。它进一步表明，CO₂气腹辅助的腹腔镜手术会阻碍炎症反应，因此可能比传统手术具有特定优势。
