Berdún S, Bombuy E, Estrada O, Mans E, Rychter J, Clavé P, Vergara P
Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Surgery, Consorci Sanitari del Maresme (CSdM) - Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain.
Neurogastroenterol Motil. 2015 Jun;27(6):764-74. doi: 10.1111/nmo.12525. Epub 2015 Feb 9.
Degranulation of peritoneal mast cells (MCs) induced by intestinal manipulation has been proposed as a pathophysiological factor in postoperative ileus (POI). We aimed to explore the relationship between peritoneal and colonic MC degranulation and gastrointestinal (GI) recovery following colectomy.
Patients undergoing elective laparoscopic cholecystectomy (using a laparoscope and small abdominal incisions, n = 14), and elective laparoscopic (n = 32) or open partial colectomy (through a large abdominal incision, n = 10) were studied. MC protease tryptase and chymase were studied in peritoneal fluid at the beginning, middle, and end of each surgical intervention. Density of MCs in colectomy samples were examined and oro-caecal transit time by breath test, GI function recovery by clinical composite endpoint GI-2 and association between MC proteases and clinical recovery.
Open and laparoscopic colectomy caused greater peritoneal release of tryptase and chymase (323.0 ng/mL [IQR: 53.05-381.4] and 118.6 ng/mL [IQR: 53.60-240.3]), than cholecystectomy (41.64 ng/mL [IQR: 11.17-90.93]) at the end of the surgical intervention. However, there were no differences between laparoscopic and open colectomy. Increased peritoneal protease release during surgery was observed in patients who developed POI after colectomy.
CONCLUSIONS & INFERENCES: Colorectal surgery causes protease release from peritoneal MCs. Protease release does not differ between both types of colectomy (laparoscopy vs laparotomy). However, MC activation is increased in colectomy patients developing POI. Therefore, degranulation of peritoneal MCs as a factor contributing to human POI after colectomy might be considered in future studies as a target to avoid POI.
肠道操作诱导的腹膜肥大细胞（MCs）脱颗粒被认为是术后肠梗阻（POI）的一个病理生理因素。我们旨在探讨结肠切除术腹膜和结肠MC脱颗粒与胃肠道（GI）恢复之间的关系。
研究了接受择期腹腔镜胆囊切除术（使用腹腔镜和小腹部切口，n = 14）以及择期腹腔镜（n = 32）或开放性部分结肠切除术（通过大腹部切口，n = 10）的患者。在每次手术干预开始、中间和结束时，研究腹膜液中的MC蛋白酶类胰蛋白酶和糜蛋白酶。检查结肠切除术样本中MCs的密度，并通过呼气试验测定口盲肠转运时间，通过临床综合终点GI-2评估GI功能恢复情况，以及MC蛋白酶与临床恢复之间的关联。
在手术干预结束时，开放性和腹腔镜结肠切除术导致的类胰蛋白酶和糜蛋白酶腹膜释放量（分别为323.0 ng/mL [IQR：53.05 - 381.4]和118.6 ng/mL [IQR：53.60 - 240.3]）高于胆囊切除术（41.64 ng/mL [IQR：11.17 - 90.93]）。然而，腹腔镜和开放性结肠切除术之间没有差异。结肠切除术后发生POI的患者在手术期间观察到腹膜蛋白酶释放增加。
结直肠手术导致腹膜MCs释放蛋白酶。两种类型的结肠切除术（腹腔镜与开腹手术）之间蛋白酶释放没有差异。然而，发生POI的结肠切除术患者中MC激活增加。因此，在未来的研究中，腹膜MCs脱颗粒作为结肠切除术后导致人类POI的一个因素，可能被视为避免POI的一个靶点。
