Poerwosusanta Hery, Oktaviyanti Ika Kustiyah, Kania Nia, Noor Zairin
Department of Surgery, Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, South Kalimantan, Indonesia.
Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gajah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia.
Ann Med Surg (Lond). 2020 Sep 2;58:102-106. doi: 10.1016/j.amsu.2020.08.043. eCollection 2020 Oct.
Laparoscopic procedures under certain pressure have the potential to cause intra-abdominal adhesions. However, the pathomechanism of this disorder is unknown. Release of mast cell mediators due to mast cell degranulation is thought to be the cause.
Thirty male Sprague-Dawley rats were grouped into five groups (n = 6 per group): one control group and four intervention groups to which 60 min insufflation was performed using carbon dioxide at 5, 8, 10 and 12 mmHg. Seven days after laparoscopy, we euthanized and evaluated the levels of histamine, tryptase, and chymase of peritoneal fluid, the thickness of ECM of peritoneal tissue, and intraabdominal adhesion scoring system.
Histamine and tryptase levels in peritoneal fluid were significantly higher at the 10- and 12 mm Hg intervention compared to control (histamine: 0.50 ± 0.35 vs. 0.41 ± 0.41 vs. 0.04 ± 0.02 ng/mL, respectively; and tryptase: 0.69 ± 0.11 vs. 0.65 ± 0.05 vs. 0.48 ± 0.02 ng/ml respectively). The ECM was significantly thicker in the intervention groups at 10- and 12-mm Hg compared to control (71.3 [66.7-85.2] vs. 48.4 [34.5-50.3] vs. 10.25 [8.7-12.1] μm, respectively). Moreover, the intra-abdominal scoring was also significantly higher in the intervention groups at 10- and 12 mm Hg compared to control (4 [0-4] vs. 4.5 [4-5], vs. 0, respectively).
Laparoscopic procedures increase the release of mast cell mediators in peritoneal fluid, the thickness of ECM and intraabdominal adhesion scoring in rats, implying that it might increase the possibility of intrabdominal adhesion in humans.
在一定压力下进行腹腔镜手术有可能导致腹腔内粘连。然而，这种病症的发病机制尚不清楚。肥大细胞脱颗粒导致肥大细胞介质的释放被认为是其病因。
将30只雄性Sprague-Dawley大鼠分为五组（每组n = 6）：一组为对照组，四组为干预组，分别使用5、8、10和12 mmHg的二氧化碳进行60分钟的气腹。腹腔镜检查7天后，我们对大鼠实施安乐死，并评估腹腔液中组胺、类胰蛋白酶和糜酶的水平、腹膜组织细胞外基质（ECM）的厚度以及腹腔粘连评分系统。
与对照组相比，10 mmHg和12 mmHg干预组腹腔液中的组胺和类胰蛋白酶水平显著更高（组胺分别为：0.50±0.35 ng/mL、0.41±0.41 ng/mL和0.04±0.02 ng/mL；类胰蛋白酶分别为：0.69±0.11 ng/mL、0.65±0.05 ng/mL和0.48±0.02 ng/mL）。与对照组相比，10 mmHg和12 mmHg干预组的ECM明显更厚（分别为71.3 [66.7 - 85.2]μm、48.4 [34.5 - 50.3]μm和10.25 [8.7 - 12.1]μm）。此外，与对照组相比，10 mmHg和12 mmHg干预组的腹腔粘连评分也显著更高（分别为4 [0 - 4]、4.5 [4 - 5]和0）。
腹腔镜手术会增加大鼠腹腔液中肥大细胞介质的释放、ECM的厚度以及腹腔粘连评分，这意味着它可能会增加人类腹腔粘连的可能性。
