Moehrlen U, Schwoebel F, Reichmann E, Stauffer U, Gitzelmann C A, Hamacher J
Department of Pediatric Surgery, University Children's Hospital, Steinwiesstrasse 75, Zurich, CH-8032, Switzerland.
Surg Endosc. 2005 Jul;19(7):958-63. doi: 10.1007/s00464-004-2118-2. Epub 2005 May 12.
The authors previously demonstrated postoperative preservation of the immune function measured by delayed-type skin reaction and tumor growth after laparoscopic surgery, as compared with laparotomy. For further elucidation of the origin of the demonstrated immune preservation, peritoneal macrophage (PMo) function was investigated 1 h after different surgical procedures.
Female NMRI mice were divided into five groups: anesthesia only, abdominal skin incision, laparotomy, peritoneal carbon dioxide (CO2) insufflation, and peritoneal air insufflation. Escherichia Coli phagocytosis, tumor necrosis factor-alpha (TNF-alpha), transforming growth factor-beta1 (TGF-beta1), and interleukin-10 (IL-10) release of isolated PMo were investigated.
All invasive interventions reduced the PMo phagocytosis by factors of approximately 2 to 4.7, as compared with the sham control group. Spontaneous ex vivo TNF-alpha release was significantly increased whenever the abdominal cavity was exposed to ambient air. The macrophage's ability to release TNF-alpha after E. coli exposure was diminished in the abdominal air exposure groups, as compared with the CO2 insufflation group.
Reduced phagocytosis 1 h after surgical interventions suggests a contribution of PMo to the altered immune function. When exposed to CO2, PMo show a decreased basal TNF-alpha release. However, PMo also show an increased TNF-alpha release after a second immune stimulation (E. coli), suggesting a greater competency of interaction in an immune defense reaction after CO2 exposure.
作者之前证明，与开腹手术相比，腹腔镜手术后通过迟发型皮肤反应和肿瘤生长测量的免疫功能得以保留。为了进一步阐明所证明的免疫保留的起源，在不同手术操作1小时后对腹膜巨噬细胞（PMo）功能进行了研究。
将雌性NMRI小鼠分为五组：仅麻醉组、腹部皮肤切开组、开腹手术组、腹膜二氧化碳（CO2）气腹组和腹膜空气气腹组。研究了分离的PMo的大肠杆菌吞噬作用、肿瘤坏死因子-α（TNF-α）、转化生长因子-β1（TGF-β1）和白细胞介素-10（IL-10）释放情况。
与假手术对照组相比，所有侵入性干预措施使PMo吞噬作用降低了约2至4.7倍。每当腹腔暴露于环境空气时，体外自发TNF-α释放显著增加。与CO2气腹组相比，腹部空气暴露组中大肠杆菌暴露后巨噬细胞释放TNF-α的能力降低。
手术干预1小时后吞噬作用降低表明PMo对免疫功能改变有影响。暴露于CO2时，PMo的基础TNF-α释放减少。然而，PMo在第二次免疫刺激（大肠杆菌）后也表现出TNF-α释放增加，表明暴露于CO2后在免疫防御反应中的相互作用能力更强。
