Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven (KULeuven), Leuven, Belgium.
Eur J Obstet Gynecol Reprod Biol. 2021 Oct;265:107-112. doi: 10.1016/j.ejogrb.2021.08.016. Epub 2021 Aug 22.
CO pneumoperitoneum (PP) during laparoscopic surgery, can cause hypoxia and desiccation in the peritoneal mesothelial cell, resulting in a time-dependent retraction and bulging of these cells, an acute inflammatory reaction and enhanced adhesion formation. Since hypoxia is prevented by adding 4% of oxygen (O) to the CO PP, the aim of this study was to evaluate the effect of adding 4% O to the CO PP on mesothelial cell morphology.
In a standardized laparoscopic mouse model (n=8 mice per group), a control group with a 30- or 60-min PP with humidified CO + 4% of O (groups I and II) was compared to a hypoxic group with 30- or 60-min humidified pure CO (groups III and IV) and a desiccation group with 60-min of dry CO PP (group V). The effect upon the peritoneum morphology was evaluated by scanning electron microscopy (SEM) of abdominal wall peritoneal biopsies. Biopsies, taken immediately (n=4) and 24 hrs (n=4) after surgery, were compared to a group without PP (group VI, n=4). SEM pictures were blindly scored for cell retraction, deletion of microvilli, fibrin deposition, holes in the epithelial layer and visibility of cell borders using a semi-quantitative scoring system.
PP Hypoxia (CO PP) has a deleterious effect upon mesothelial morphology, immediately (holes: p= 0.04) and 24 hrs later (cell retraction: p=0.005; total score: p=0.03) . Desiccation has also a deleterious effect immediately (microvilli p=0.0090; fibrin deposition p=0.05) and 24 hrs after surgery (cell retraction: p=0.0036; holes: p=0.0004; microvilli: p< 0.0001, fibrin deposition: p=0.0225; borders: p=0.0007). This deleterious effect increases with duration of CO PP, affecting cell retraction (p=0.016), holes (p=0.0441), and the total score (p=0.0488). The addition of 4% of O to the CO PP failed to reach statistical significance.
These data confirm that CO PP and dry gas have a deleterious effect on mesothelial cell morphology. Humidification of the insufflation gas reduces this deleterious effect. The hypothesis of a protective effect of adding O failed to reach significance.
腹腔镜手术中的 CO 气腹会导致腹膜间皮细胞缺氧和干燥，导致这些细胞发生时间依赖性回缩和膨出、急性炎症反应和增强的黏附形成。由于在 CO 气腹内添加 4%的氧气（O）可以防止缺氧，因此本研究旨在评估在 CO 气腹内添加 4%的 O 对间皮细胞形态的影响。
在标准化的腹腔镜小鼠模型中（每组 8 只小鼠），与加湿 CO+4%的 O 的 30 或 60 分钟气腹的对照组（I 组和 II 组）进行比较，包括 30 或 60 分钟加湿纯 CO 的缺氧组（III 组和 IV 组）和 60 分钟干燥 CO 气腹的干燥组（V 组）。通过对腹壁腹膜活检进行扫描电子显微镜（SEM）评估对腹膜形态的影响。在手术结束后立即（n=4）和 24 小时（n=4）取出活检，并与无气腹组（VI 组，n=4）进行比较。使用半定量评分系统对 SEM 图片进行细胞回缩、微绒毛缺失、纤维蛋白沉积、上皮层中的孔和细胞边界的可见性进行盲法评分。
气腹缺氧（CO 气腹）对间皮形态具有有害影响，立即（孔：p=0.04）和 24 小时后（细胞回缩：p=0.005；总评分：p=0.03）。干燥也具有有害影响，立即（微绒毛：p=0.0090；纤维蛋白沉积：p=0.05）和手术后 24 小时（细胞回缩：p=0.0036；孔：p=0.0004；微绒毛：p<0.0001，纤维蛋白沉积：p=0.0225；边界：p=0.0007）。这种有害影响随着 CO 气腹时间的延长而增加，影响细胞回缩（p=0.016）、孔（p=0.0441）和总评分（p=0.0488）。在 CO 气腹内添加 4%的 O 未达到统计学意义。
这些数据证实 CO 气腹和干燥气体对间皮细胞形态具有有害影响。充气气体的加湿减少了这种有害影响。添加 O 的保护作用的假设未达到显著性。
