Papparella Alfonso, Nino Fabiano, Coppola Sandra, Noviello Carmine, Paciello Orlando, Papparella Serenella
Department of Pediatric Surgery, Second University of Naples, Naples, Italy.
Department of Pediatric Surgery, Salesi Hospital, Ancona, Italy.
Eur J Pediatr Surg. 2014 Aug;24(4):322-7. doi: 10.1055/s-0033-1349057. Epub 2013 Jun 25.
Carbon dioxide (CO2) used in laparoscopy evokes local and systemic effects. This study was designed to evaluate the histopathologic morphologic changes due to CO2 and air insufflation, at different pressure levels, on visceral and parietal peritoneum in rats.
A total of 56 rats were object of the study, randomly divided into five groups. Pneumoperitoneum (PN) was maintained for 30 minutes, at a flow rate of 0.5 L/min and at a pressure of 10 and 6 mm Hg with CO2 (group S1-S2, n = 32) and filtered air (group A1-A2, n = 16). Only anesthesia was performed in the fifth group (group C, n = 8). Peritoneal samples were obtained 24 hours later for blinded histological evaluation. A grading system was adopted to evaluate histological peritoneal changes (0, no change; 1, mild; 2, moderate; and 3, severe) such as mesothelial aspect, inflammatory response, edema, and hemorrhage. The score reflected the severity of damage and was calculated by the sum of the degree evaluated separately. Values were compared with the analysis of variance analysis.
CO2 and air insufflation caused reactive mesothelial cells and peritoneal inflammation of different degrees depending on the level of intra-abdominal pressure (IAP) and type of gas. These modifications were absent in group C and were less evident in low pressure S2 group with respect to S1 and A1-A2 groups. The average values of histopathologic peritoneal score showed significant differences between S2 (11.5) versus S1 groups (16.83) with respect to A groups (A1 = 27.83; A2 = 20.5) and compared with the controls (C = 2.5).
Our data confirm that PN affects the peritoneal integrity. The grades of morphological peritoneal changes are related to the level of IAP. Low CO2 pressure causes minor peritoneal changes with respect to high pressure and air insufflation.
腹腔镜手术中使用的二氧化碳（CO₂）会引起局部和全身效应。本研究旨在评估不同压力水平下，CO₂和空气充气对大鼠内脏和壁层腹膜造成的组织病理学形态学变化。
共有56只大鼠作为研究对象，随机分为五组。气腹（PN）维持30分钟，流速为0.5L/分钟，CO₂组（S1 - S2组，n = 32）压力为10和6mmHg，过滤空气组（A1 - A2组，n = 16）压力为10和6mmHg。第五组（C组，n = 8）仅进行麻醉。24小时后获取腹膜样本进行盲法组织学评估。采用分级系统评估腹膜组织学变化（0级，无变化；1级，轻度；2级，中度；3级，重度），如间皮外观、炎症反应、水肿和出血。该评分反映损伤的严重程度，通过分别评估的程度总和计算得出。采用方差分析比较数值。
CO₂和空气充气根据腹内压（IAP）水平和气体类型导致不同程度的反应性间皮细胞和腹膜炎症。C组未出现这些改变，且与S1和A1 - A2组相比，低压S2组的这些改变不太明显。组织病理学腹膜评分的平均值显示，S2组（11.5）与S1组（16.83）相比，A组（A1 = 27.83；A2 = 20.5）以及与对照组（C = 2.5）相比均存在显著差异。
我们的数据证实气腹会影响腹膜完整性。腹膜形态学变化的等级与IAP水平相关。与高压和空气充气相比，低CO₂压力导致的腹膜变化较小。
