Department of Gastroenterology, and daggerMedical School and Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
Pancreas. 2010 Mar;39(2):175-81. doi: 10.1097/MPA.0b013e3181bd651a.
Acute pancreatitis (AP) is a serious disease that is amplified by an associated systemic inflammatory response. We investigated the effect of CO2 pneumoperitoneum on the local and systemic inflammatory response in AP.
Acute pancreatitis was induced in Wistar rats by 5% taurocholate intraductal injection. Carbon dioxide pneumoperitoneum was applied for 30 minutes before the induction of AP. Inflammatory parameters were evaluated in the peritoneum (ascites, cell number, and tumor necrosis factor alpha [TNF-alpha]), serum (amylase, TNF-alpha, interleukin-6 [IL-6], and IL-10), pancreas (myeloperoxidase [MPO] activity, cyclo-oxygenase 2 and inducible nitric oxide synthase expression, and histological diagnosis), liver, and lung (mitochondria dysfunction and MPO activity).
Abdominal insufflation with CO2 before induction of AP caused a significant decrease in ascites volume, cells, and TNF-alpha in the peritoneal cavity and in serum TNF-alpha and IL-6 but not IL-10 levels. In the pancreas, this treatment reduced MPO activity, acinar and fat necrosis, and the expression of inducible nitric oxide synthase and cyclo-oxygenase 2. There were no significant differences on serum amylase levels, liver mitochondrial function, and pulmonary MPO between groups.
Our data demonstrated that CO2 pneumoperitoneum reduced pancreatic inflammation and attenuated systemic inflammatory response in AP. This article suggests that CO2 pneumoperitoneum plays a critical role on the better outcome in patients undergoing laparoscopic pancreatic surgery.
急性胰腺炎（AP）是一种严重的疾病，会引发相关的全身炎症反应。本研究旨在探讨 CO2 气腹对 AP 局部和全身炎症反应的影响。
通过胰胆管内注射 5%牛磺胆酸钠诱导 Wistar 大鼠急性胰腺炎。在诱导 AP 前 30 分钟进行 CO2 气腹。评估腹膜（腹水、细胞数和肿瘤坏死因子-α[TNF-α]）、血清（淀粉酶、TNF-α、白细胞介素-6[IL-6]和 IL-10）、胰腺（髓过氧化物酶[MPO]活性、环氧化酶 2 和诱导型一氧化氮合酶表达以及组织学诊断）、肝脏和肺脏（线粒体功能障碍和 MPO 活性）中的炎症参数。
AP 诱导前腹部 CO2 充气导致腹腔内腹水体积、细胞和 TNF-α以及血清 TNF-α和 IL-6 水平显著降低，但 IL-10 水平无显著差异。这种治疗方法还降低了 MPO 活性、腺泡和脂肪坏死以及诱导型一氧化氮合酶和环氧化酶 2 的表达。两组间血清淀粉酶水平、肝线粒体功能和肺脏 MPO 无显著差异。
我们的数据表明，CO2 气腹可减轻 AP 时的胰腺炎症并减轻全身炎症反应。本文提示 CO2 气腹在接受腹腔镜胰腺手术的患者中具有更好的结局中发挥了关键作用。
