Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Laboratory of Histology and Embryology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Surgery. 2022 Apr;171(4):973-979. doi: 10.1016/j.surg.2021.11.002. Epub 2021 Dec 6.
Major liver resection may compromise gut-barrier function, increasing the risk of postoperative infectious complications. The aim of the present experimental study was to compare the effect of the laparoscopic versus the open technique for major liver resection on integrity as well as inflammatory and immune responses of the gut barrier.
Wistar rats were subjected to open 70% hepatectomy (group H), laparoscopic 70% hepatectomy (group LH), sham operation (group S) or no intervention (group C). At various timepoints (1 hour-1 week) after operation, ileal tissue was excised for oxidative state assessment (TBARS levels), histopathologic examination, histomorphometric analysis, immunohistochemical assessment of the mitotic and apoptotic activity, and tissue expression of inflammatory (interleukin-6, tumor necrosis factor-α, nuclear factor-κB and vascular cell adhesion molecule-1) and immune response biomarkers (CD4 and CD8 T-lymphocytes) of the intestinal mucosa.
No changes were noted in oxidative state. The histopathologic profile was less deteriorated in group LH compared to group H. Intestinal mucosa atrophy was less intense in group LH compared to group H and was related to an equally compromised crypt cell mitotic activity. Tissue overexpression of interleukin-6, tumor necrosis factor-α, nuclear factor-κΒ, vascular cell adhesion molecule-1, CD4, and CD8 T-lymphocytes was less pronounced in group LH compared to group H.
The employment of the laparoscopic technique for major liver resection in the rat attenuated disruption of the gut barrier compared to the open procedure. This was related to less pronounced inflammatory and immune responses of the intestinal mucosa.
大肝切除可能会损害肠道屏障功能，增加术后感染并发症的风险。本实验研究的目的是比较腹腔镜与开腹技术行大肝切除对肠道屏障完整性及炎症和免疫反应的影响。
Wistar 大鼠行开腹 70%肝切除术（H 组）、腹腔镜 70%肝切除术（LH 组）、假手术（S 组）或无干预（C 组）。术后 1 小时至 1 周的不同时间点，切除回肠组织进行氧化状态评估（TBARS 水平）、组织病理学检查、组织形态计量分析、有丝分裂和凋亡活性的免疫组织化学评估以及肠道黏膜的炎症（白细胞介素-6、肿瘤坏死因子-α、核因子-κB 和血管细胞黏附分子-1）和免疫反应生物标志物（CD4 和 CD8 T 淋巴细胞）的组织表达。
氧化状态没有变化。LH 组的组织病理学特征较 H 组恶化程度较轻。LH 组的肠黏膜萎缩程度较 H 组轻，与隐窝细胞有丝分裂活性同样受损有关。LH 组组织中白细胞介素-6、肿瘤坏死因子-α、核因子-κB、血管细胞黏附分子-1、CD4 和 CD8 T 淋巴细胞的过度表达较 H 组减轻。
与开腹手术相比，腹腔镜技术行大肝切除在大鼠中减轻了肠道屏障的破坏。这与肠道黏膜炎症和免疫反应程度较轻有关。
