Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
BJOG. 2010 Feb;117(3):331-9. doi: 10.1111/j.1471-0528.2009.02370.x. Epub 2009 Oct 13.
CO(2) pneumoperitoneum with more than 10% oxygen enhances adhesions. As during open surgery the peritoneum is exposed to air (20% oxygen), in this hyperoxia-enhanced adhesion model we evaluated the effect of hypothermia and products with known effectiveness in hypoxia (pure CO(2) pneumoperitoneum) and normoxia (CO(2) pneumoperitoneum plus 3-4% oxygen) models. Results were expected to be important for adhesion prevention in open surgery, and, moreover, similarities and differences between the three models would be important to identify differences in pathways of adhesion formation between laparoscopy and laparotomy.
Two experiments were performed in which the effect of hypothermia (32 degrees C), a surfactant (phospholipids), a barrier (Hyalobarrier gel), reactive oxygen species scavengers (superoxide dismutase, SOD, and ascorbic acid, AA), anti-inflammatory agents (dexamethasone and nimesulide), a calcium channel blocker (diltiazem) and recombinant plasminogen activator (r-PA) were evaluated upon adhesions.
University Hospital.
BALB/c mice.
Hyperoxia-enhanced adhesions were induced by performing laparoscopically bipolar lesions during 60 minutes of CO(2) pneumoperitoneum plus 12% oxygen at 37 degrees C body temperature.
Adhesions were scored after 7 days.
In this model, adhesions were reduced by hypothermia (P < 0.02; Wilcoxon), phospholipids (P = 0.03), Hyalobarrier gel (P < 0.004), dexamethasone (P < 0.005) and diltiazem (P < 0.01). A significant but quantitatively borderline effect was seen for AA (P < 0.002) and r-PA (P = 0.0005), whereas SOD and nimesulide did not have any effect.
Hyperoxia-enhanced adhesions were prevented by hypothermia, dexamethasone, phospholipids, Hyalobarrier gel, diltiazem, r-PA and AA. All effects were similar to those in the hypoxia-enhanced adhesion model, suggesting that the underlying mechanisms are similar.
CO(2)气腹超过 10%的氧气可增强粘连。由于在开放性手术中，腹膜暴露于空气中（20%的氧气），因此在这种高氧增强粘连模型中，我们评估了低温和已知在缺氧（纯 CO(2)气腹）和正常氧（CO(2)气腹加 3-4%氧气）模型中有效产品的影响。这些结果对开放性手术中的粘连预防非常重要，而且，三种模型之间的相似性和差异性对于确定腹腔镜和剖腹术之间粘连形成途径的差异非常重要。
进行了两项实验，评估了低温（32°C）、表面活性剂（磷脂）、屏障（Hyalobarrier 凝胶）、活性氧物质清除剂（超氧化物歧化酶、SOD 和抗坏血酸、AA）、抗炎剂（地塞米松和尼美舒利）、钙通道阻滞剂（地尔硫卓）和重组纤溶酶原激活剂（r-PA）对粘连的影响。
大学医院。
BALB/c 小鼠。
通过在 37°C 体温下进行 60 分钟的 CO(2)气腹加 12%氧气的腹腔镜双极损伤，诱导高氧增强粘连。
术后 7 天进行粘连评分。
在该模型中，低温（P < 0.02；Wilcoxon）、磷脂（P = 0.03）、Hyalobarrier 凝胶（P < 0.004）、地塞米松（P < 0.005）和地尔硫卓（P < 0.01）可减少粘连。AA（P < 0.002）和 r-PA（P = 0.0005）也有显著但数量上的边缘效应，但 SOD 和尼美舒利没有任何作用。
低温、地塞米松、磷脂、Hyalobarrier 凝胶、地尔硫卓、r-PA 和 AA 均可预防高氧增强粘连。所有的效果都与缺氧增强粘连模型相似，表明潜在的机制相似。
