Bulbuloglu Ertan, Yildiz Huseyin, Senoglu Nimet, Coskuner Ismail, Yuzbasioglu M Fatih, Kilinc Metin, Dogan Zafer, Deniz Caglayan, Oksuz Hafize, Kantarçeken Bulent, Atli Yalcın
Department of General Surgery, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey.
J Laparoendosc Adv Surg Tech A. 2011 Dec;21(10):947-51. doi: 10.1089/lap.2011.0194. Epub 2011 Nov 1.
Pneumoperitoneum induced to facilitate laparoscopy is associated with splanchnic hypoperfusion, ischemia/reperfusion (I/R) injury, and oxidative stress.
This study investigated the effects of pre- and postlaparoscopic conditioning, zinc, pentoxifylline, and N-acetylcysteine on markers of I/R injury of the small intestine in an animal model.
Male Sprague-Dawley rats (n=56) were randomized to 1 of 7 treatment groups. Except for group 7 (control group that underwent sham surgery without pneumoperitoneum), pneumoperitoneum was induced in all by use of carbondioxide insufflation under a pressure of 15 mmHg. Group 1 (laparoscopic I/R) was subjected to 60 minutes of pneumoperitoneum. Group 2 (laparoscopic preconditioning plus laparoscopy) was subjected to 5 minutes of insufflation and 5 minutes of desufflation followed by 60 minutes of pneumoperitoneum. Group 3 (laparoscopy plus laparoscopic postconditioning) was subjected to 60 minutes of pneumoperitoneum and 60 minutes of desufflation followed by 5 minutes of insufflation and 5 minutes of desufflation. Group 4 (zinc), group 5 (pentoxifylline), and group 6 (N-acetylcysteine) received a single intraperitoneal injection of zinc (50 mg/kg), pentoxifylline (50 mg/kg), or N-acetylcysteine (150 mg/kg), respectively, 5 minutes before the desufflation period. Animals were killed at the end of the experiments, and small intestine samples were tested for malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPX), and superoxide dismutase (SOD).
There was no significant difference for MDA levels between each other in the groups 1, 2, and 3. But MDA levels were higher significantly in groups 1, 2, and 3 than those of groups 4, 5, 6, and 7. SOD and GPX levels of group 3 were significantly higher than those of groups 1, 2, 4 through 7. According to the SOD levels, there was no significant difference between each other in those of groups 1, 2, 4 through 7. GPX levels of group 3 were significantly higher than those of groups 1, 2, 4 through 7. GPX levels of group 1 were significantly lower than those of groups 5 and 7. The mean CAT level of groups 1 and 2 was significantly lower than that of groups 3, 6, and 7. The mean CAT level of group 3 was significantly higher than that of groups 1, 2, 4 through 7.
In this animal model of small intestine I/R injury, laparoscopy caused small intestine ischemia as evidenced by elevated markers of tissue I/R injury. This effect was significantly attenuated by zinc, pentoxifylline, and N-acetylcysteine, but not by prelaparoscopy conditioning and postlaparoscopy conditioning.
为便于进行腹腔镜检查而诱导产生的气腹与内脏低灌注、缺血/再灌注（I/R）损伤及氧化应激相关。
本研究在动物模型中探究腹腔镜术前和术后预处理、锌、己酮可可碱及N-乙酰半胱氨酸对小肠I/R损伤标志物的影响。
将56只雄性Sprague-Dawley大鼠随机分为7个治疗组中的1组。除第7组（接受无气腹假手术的对照组）外，其余各组均通过在15 mmHg压力下注入二氧化碳诱导产生气腹。第1组（腹腔镜I/R组）接受60分钟气腹。第2组（腹腔镜预处理加腹腔镜检查组）先进行5分钟充气和5分钟放气，随后进行60分钟气腹。第3组（腹腔镜检查加腹腔镜术后预处理组）先进行60分钟气腹和60分钟放气，随后进行5分钟充气和5分钟放气。第4组（锌组）、第5组（己酮可可碱组）和第6组（N-乙酰半胱氨酸组）在放气期前5分钟分别腹腔注射锌（50 mg/kg）、己酮可可碱（50 mg/kg）或N-乙酰半胱氨酸（150 mg/kg）。实验结束时处死动物，检测小肠样本中的丙二醛（MDA）、过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GPX）和超氧化物歧化酶（SOD）。
第1、2、3组之间MDA水平无显著差异。但第1、2、3组的MDA水平显著高于第4、5、6、7组。第3组的SOD和GPX水平显著高于第1、2、4至7组。根据SOD水平，第1、2、4至7组之间无显著差异。第3组的GPX水平显著高于第1、2、4至7组。第1组的GPX水平显著低于第5组和第7组。第1组和第2组的平均CAT水平显著低于第3、6、7组。第3组的平均CAT水平显著高于第1、2、4至7组。
在这个小肠I/R损伤动物模型中，腹腔镜检查导致小肠缺血，组织I/R损伤标志物升高证明了这一点。锌、己酮可可碱和N-乙酰半胱氨酸可显著减轻这种效应，但腹腔镜术前预处理和腹腔镜术后预处理则无此作用
