Pitombo M B, Lupi O H, Gomes R N, Amâncio R, Refinetti R A, Bozza P T, Castro-Faria-Neto H C
Departamento de Cirurgia Geral, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, UERJ, AV 28 de setbmbno 77, 40 Andar, Rio de Janeino, RJ, Brazil, 20550-030.
Surg Endosc. 2006 Sep;20(9):1440-7. doi: 10.1007/s00464-005-0117-6. Epub 2006 May 15.
The immunologic repercussions due to cavity insufflation are the focus of great discussion. The aim of this study was to compare the inflammatory response and bacterial dissemination after laparotomy and abdominal CO2 insufflation in a murine model of peritonitis.
Swiss mice were inoculated intraperitoneally with 0.5 ml of a solution containing 1 x 10(8) colony-forming units (CFU)/ml of Escherichia coli and were divided into three groups as follow: control (anesthesia for 30 min), laparotomy (2.5-cm midline incision for 30 min), and CO2 pneumoperitoneum (CO2 cavity insufflation for 30 min). The number of leukocytes, CFU/ml counting, and the levels of interleukin (IL)-6, tumor necrosis factor-alpha (TNF-alpha), and IL-10 were evaluated in blood, peritoneal, and pleural fluid samples obtained at 90 min and 18 h after the procedures.
The laparotomy group showed a greater bacterial dissemination to the blood, peritoneum, and pleural cavity and also greater neutrophil migration to the peritoneal cavity compared to the CO2 insufflated and control groups. The 24-h mortality was also significantly higher in the laparotomy group. The IL-6 levels showed a precocious rise in all groups submitted to bacterial inoculation at the 90-min time point. At the 18-h time point, IL-6 levels in the peritoneum were significantly higher in the laparotomy group than in the control or CO2 insufflated groups. At the same time, TNF-alpha levels were higher in the laparotomy and CO2 insufflated groups than in controls; IL-10 levels showed no differences among the groups.
Our results suggest that cavity insufflation with CO2 is a more effective method of access, inducing less bacterial dissemination and also a less intense inflammatory response. Cavity insufflation with CO2 may present a good option for the surgical treatment of patients with bacterial peritonitis.
气腹引起的免疫反应是广泛讨论的焦点。本研究的目的是在小鼠腹膜炎模型中比较剖腹术和腹腔二氧化碳气腹术后的炎症反应及细菌播散情况。
给瑞士小鼠腹腔内接种0.5 ml含1×10⁸菌落形成单位（CFU）/ml大肠杆菌的溶液，并分为三组：对照组（麻醉30分钟）、剖腹术组（中线切口2.5 cm，持续30分钟）和二氧化碳气腹组（二氧化碳气腹30分钟）。在术后90分钟和18小时采集血液、腹腔和胸腔积液样本，评估白细胞数量、CFU/ml计数以及白细胞介素（IL）-6、肿瘤坏死因子-α（TNF-α）和IL-10水平。
与二氧化碳气腹组和对照组相比，剖腹术组向血液、腹膜和胸腔的细菌播散更多，中性粒细胞向腹腔的迁移也更多。剖腹术组24小时死亡率也显著更高。在90分钟时间点，所有接种细菌的组中IL-6水平均出现早熟升高。在18小时时间点，剖腹术组腹膜中的IL-6水平显著高于对照组或二氧化碳气腹组。同时，剖腹术组和二氧化碳气腹组的TNF-α水平高于对照组；各组间IL-10水平无差异。
我们的结果表明，二氧化碳气腹是一种更有效的进入方法，可减少细菌播散，炎症反应也较轻。二氧化碳气腹可能是细菌性腹膜炎患者手术治疗的一个良好选择。
