Yilmaz Sezgin, Uyar Hilmi, Aktepe Fatma, Akaydin Murat, Cilekar Murat, Vurmaz Ayhan, Koca Bugra, Kahraman Ahmet, Arikan Yuksel
General Surgery Department, Afyon Kocatepe University, Afyon, Turkey.
J Laparoendosc Adv Surg Tech A. 2012 Jan-Feb;22(1):34-9. doi: 10.1089/lap.2011.0373. Epub 2011 Dec 8.
Laparoscopic cholecystectomy, particularly in the same hospital stay, has been widely recommended to treat gallstone-pancreatitis over the last decade. Although pancreatitis produces severe oxidative injury, laparoscopy exerts an additional effect over that is produced by pancreatitis. The preconditioning phenomenon previously reported as protective in open surgery is a beneficial maneuver also in laparoscopic surgery. So in the present study we have tried to find out the effect of laparoscopic preconditioning over the pancreatitis in cerulein-induced pancreatitis rats.
Acute pancreatitis was induced in 24 rats weighing between 280 and 350 g by three subcutaneous injection of 80 μg/kg of body weight cerulein. A 1-cm midline laparotomy was performed for all rats, and then they were randomly assigned to one of the following three groups (n=8 for each): Group I (control), Group II (laparoscopy), and Group III (laparoscopic preconditioning [L-Pre]). After that, a catheter was placed into the peritoneum for the creation of the pneumoperitoneum (Pp) in all the animals except the control group. The rats of Groups II and III were subjected to 60 minutes of Pp with 15 mm Hg intraabdominal pressure followed by 30 minutes of deflation. The L-Pre procedure was applied to Group III immediately before the laparoscopic procedure. Blood samples were taken for biochemical assays. Pancreas tissue samples were taken for light microscope analysis.
The light microscopy of the pancreas tissues revealed that cerulein injection caused edema and sparse inflammatory cell infiltration mimicking the edematous pancreatitis. However, the application of laparoscopy over the pancreatitis produced significant inflammatory cell infiltration, acinus vacuolization, and necrosis (in one case) in addition to edema. But, the laparoscopic preconditioning maneuver applied before the laparoscopy significantly decreased in particular acinary vacuolization and cell infiltration. Therefore the total sum of the histopathological score of the L-Pre group was significantly less than that of the laparoscopy group. The biochemical analysis of the groups revealed that laparoscopy caused significant elevation of malondialdehyde levels and decrease of reduced glutathione values. However, the addition of preceding preconditioning produced significant amelioration of these parameters.
Laparoscopic preconditioning may be a useful method to decrease the oxidative injury in cases undergoing cholecystectomy for biliary pancreatitis. But, it should be emphasized that this was a restricted experimental study, and further clinical studies are needed to adopt these results into clinical settings.
在过去十年中，腹腔镜胆囊切除术，尤其是在同一住院期间进行的手术，已被广泛推荐用于治疗胆石性胰腺炎。尽管胰腺炎会产生严重的氧化损伤，但腹腔镜手术会对胰腺炎所产生的损伤产生额外影响。先前报道在开放手术中具有保护作用的预处理现象在腹腔镜手术中也是一种有益的操作。因此，在本研究中，我们试图探究腹腔镜预处理对雨蛙肽诱导的胰腺炎大鼠胰腺炎的影响。
对24只体重在280至350克之间的大鼠，通过皮下注射三次80微克/千克体重的雨蛙肽诱导急性胰腺炎。对所有大鼠进行1厘米的中线剖腹术，然后将它们随机分为以下三组之一（每组n = 8）：第一组（对照组）、第二组（腹腔镜组）和第三组（腹腔镜预处理[L-Pre]组）。之后，除对照组外，在所有动物的腹膜内放置一根导管以建立气腹（Pp）。第二组和第三组的大鼠接受60分钟腹腔内压力为15毫米汞柱的气腹，随后放气30分钟。L-Pre程序在腹腔镜手术前立即应用于第三组。采集血样进行生化分析。采集胰腺组织样本进行光学显微镜分析。
胰腺组织的光学显微镜检查显示，注射雨蛙肽导致水肿和稀疏的炎性细胞浸润，类似于水肿性胰腺炎。然而，对胰腺炎进行腹腔镜手术除了水肿外，还产生了显著的炎性细胞浸润、腺泡空泡化和坏死（1例）。但是，在腹腔镜手术前应用腹腔镜预处理操作尤其显著降低了腺泡空泡化和细胞浸润。因此，L-Pre组的组织病理学评分总和显著低于腹腔镜组。对各组的生化分析显示，腹腔镜手术导致丙二醛水平显著升高，还原型谷胱甘肽值降低。然而，预先进行预处理可显著改善这些参数。
腹腔镜预处理可能是一种有用的方法，可减少因胆源性胰腺炎而行胆囊切除术患者的氧化损伤。但是，应该强调的是，这是一项局限性的实验研究，需要进一步的临床研究将这些结果应用于临床实践。
