Gomez-Pinilla Pedro J, Binda Maria M, Lissens Ann, Di Giovangiulio Martina, van Bree Sjoerd H, Nemethova Andrea, Stakenborg Nathalie, Farro Giovanna, Bosmans Goele, Matteoli Gianluca, Deprest Jan, Boeckxstaens Guy E
Translational Research in GastroIntestinal Disorders (TARGID) and Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
Neurogastroenterol Motil. 2014 Sep;26(9):1238-47. doi: 10.1111/nmo.12376. Epub 2014 Jun 26.
Postoperative ileus (POI) is characterized by impaired gastrointestinal motility resulting from intestinal handling-associated inflammation. The introduction of laparoscopic surgery has dramatically reduced the duration of POI. However, it remains unclear to what extent this results in a reduction of intestinal inflammation. The aim of the present study is to compare the degree of intestinal inflammation and gastrointestinal transit following laparoscopic surgery and open abdominal surgery.
Mice were subjected to laparoscopic surgery or laparotomy alone or, in combination with standardized intestinal manipulation of the small bowel (IM). Gastrointestinal transit and intestinal inflammation were assessed 24 h after surgery by the number of myeloperoxidase (MPO) positive cells and the level of cytokine expression. The recovery time and the degree of inflammation were also analyzed in patients subjected to colectomy under open conditions (laparotomy) or laparoscopic conditions.
Mice undergoing IM by laparotomy (open IM), but not by laparoscopy (Lap IM) developed a significant delay in gastrointestinal transit compared to laparotomy or laparoscopy alone. In addition, there was significant intestinal inflammation only after open IM. Similarly, cytokine levels in peritoneal lavage fluid were lower while recovery time was faster in patients subjected to colectomy under laparoscopic conditions compared to open colectomy.
CONCLUSIONS & INFERENCES: Our data confirms that intestinal inflammation is underlying the delayed gastrointestinal transit observed after open surgery. Most importantly, we demonstrate that intestinal inflammation under laparoscopic conditions is significantly lower compared to open surgery, most likely explaining the faster recovery following laparoscopic surgery.
术后肠梗阻（POI）的特征是肠道处理相关炎症导致胃肠动力受损。腹腔镜手术的引入显著缩短了POI的持续时间。然而，尚不清楚这在多大程度上导致肠道炎症的减轻。本研究的目的是比较腹腔镜手术和开腹手术后肠道炎症程度和胃肠运输情况。
对小鼠进行单独的腹腔镜手术或剖腹手术，或与标准化的小肠肠道操作（IM）联合进行。术后24小时通过髓过氧化物酶（MPO）阳性细胞数量和细胞因子表达水平评估胃肠运输和肠道炎症。对接受开腹（剖腹手术）或腹腔镜手术条件下结肠切除术的患者的恢复时间和炎症程度也进行了分析。
与单独的剖腹手术或腹腔镜手术相比，通过剖腹手术进行IM（开腹IM）的小鼠出现了明显的胃肠运输延迟，但通过腹腔镜进行IM（腹腔镜IM）的小鼠没有。此外，仅在开腹IM后出现了明显的肠道炎症。同样，与开腹结肠切除术相比，腹腔镜手术条件下接受结肠切除术的患者腹腔灌洗液中的细胞因子水平较低，恢复时间更快。
我们的数据证实，肠道炎症是开腹手术后观察到的胃肠运输延迟的基础。最重要的是，我们证明腹腔镜手术条件下的肠道炎症明显低于开腹手术，这很可能解释了腹腔镜手术后恢复更快的原因。
