The Postdoctoral Workstation, General Surgery Center of PLA, General Hospital of Chengdu Military Command, Chengdu 610083, Sichuan Province, China.
World J Gastroenterol. 2011 Aug 21;17(31):3652-8. doi: 10.3748/wjg.v17.i31.3652.
To observe the hepatic injury induced by carbon dioxide pneumoperitoneum (CDP) in rabbits, compare the effects of low- and high-pressure pneumoperitoneum, and to determine the degree of hepatic injury induced by these two clinically relevant CDP pressures.
Thirty healthy male New Zealand rabbits weighing 3.0 to 3.5 kg were randomly divided into three groups (n = 10 for each group) and subjected to the following to CDP pressures: no gas control, 10 mmHg, or 15 mmHg. Histological changes in liver tissues were observed with hematoxylin and eosin staining and transmission electron microscopy. Liver function was evaluated using an automatic biochemical analyzer. Adenine nucleotide translocator (ANT) activity in liver tissue was detected with the atractyloside-inhibitor stop technique. Bax and Bcl-2 expression levels were detected by western blotting.
Liver functions in the 10 mmHg and 15 mmHg experimental groups were significantly disturbed compared with the control group. After CDP, the levels of alanine transaminase and aspartate transaminase were 77.3 ± 14.5 IU/L and 60.1 ± 11.4 IU/L, respectively, in the 10 mmHg experimental group and 165.1 ± 19.4 IU/L and 103.8 ± 12.3 IU/L, respectively, in the 15 mmHg experimental group, which were all higher than those of the control group (P < 0.05). There was no difference in pre-albumin concentration between the 10 mmHg experimental group and the control group, but the pre-albumin level of the 15 mmHg experimental group was significantly lower than that of the control group (P < 0.05). No significant differences were observed in the levels of total bilirubin or albumin among the three groups. After 30 and 60 min of CDP, pH was reduced (P < 0.05) and PaCO₂ was elevated (P < 0.05) in the 10 mmHg group compared with controls, and these changes were more pronounced in the 15 mmHg group. Hematoxylin and eosin staining showed no significant change in liver morphology, except for mild hyperemia in the two experimental groups. Transmission electron microscopy showed mild mitochondrial swelling in hepatocytes of the 10 mmHg group, and this was more pronounced in the 15 mmHg group. No significant difference in ANT levels was found between the control and 10 mmHg groups. However, ANT concentration was significantly lower in the 15 mmHg group compared with the control group. The expression of hepatic Bax was significantly increased in the two experimental groups compared with the controls, but there were no differences in Bcl-2 levels among the three groups. Twelve hours after CDP induction, the expression of hepatic Bax was more significant in the 15 mmHg group than in the 10 mmHg group.
A CDP pressure of 15 mmHg caused more substantial hepatic injury, such as increased levels of acidosis, mitochondrial damage, and apoptosis; therefore, 10 mmHg CDP is preferable for laparoscopic operations.
观察二氧化碳气腹（CDP）对兔肝脏的损伤作用，比较低、高压气腹的影响，确定这两种临床相关 CDP 压力引起的肝损伤程度。
30 只健康雄性新西兰大白兔，体重 3.0 至 3.5 千克，随机分为三组（每组 10 只），分别接受无气体对照、10mmHg 或 15mmHg 的 CDP 压力。通过苏木精和伊红染色和透射电子显微镜观察肝组织的组织学变化。使用自动生化分析仪评估肝功能。用阿托瑞酸盐抑制停止技术检测肝组织中的腺嘌呤核苷酸转位酶（ANT）活性。通过蛋白质印迹法检测 Bax 和 Bcl-2 的表达水平。
与对照组相比，10mmHg 和 15mmHg 实验组的肝功能明显受到干扰。在 CDP 后，10mmHg 实验组的丙氨酸转氨酶和天冬氨酸转氨酶水平分别为 77.3±14.5IU/L 和 60.1±11.4IU/L，15mmHg 实验组分别为 165.1±19.4IU/L 和 103.8±12.3IU/L，均高于对照组（P<0.05）。10mmHg 实验组的前白蛋白浓度与对照组无差异，但 15mmHg 实验组的前白蛋白水平明显低于对照组（P<0.05）。三组总胆红素或白蛋白水平无差异。与对照组相比，10mmHg 组在 CDP 后 30 分钟和 60 分钟时 pH 值降低（P<0.05），PaCO₂升高（P<0.05），而 15mmHg 组的变化更为明显。苏木精和伊红染色显示肝形态无明显变化，仅两组均有轻度充血。透射电镜显示 10mmHg 组肝细胞线粒体轻度肿胀，而 15mmHg 组更为明显。对照组和 10mmHg 组之间的 ANT 水平无显著差异。然而，与对照组相比，15mmHg 组的 ANT 浓度显著降低。与对照组相比，两组实验动物的肝 Bax 表达均显著增加，但三组间 Bcl-2 水平无差异。CDP 诱导 12 小时后，15mmHg 组肝 Bax 的表达明显高于 10mmHg 组。
15mmHg 的 CDP 压力引起更显著的肝损伤，如酸中毒、线粒体损伤和细胞凋亡增加；因此，腹腔镜手术时 10mmHg CDP 更为可取。
