Objective To investigate the influence of CO2-insufflation pressure on invasion potential of the colon cancer cells. Methods With an in vitro artificial pneumoperitoneum model, SW1116 human colon cancer cells were exposed to CO2-insufflation of 5 different pressure groups: 6, 9, 12, 15 mm Hg and control group, respectively for 1 h. The invasion capacities of SW1116 cells exposed to CO2-insufflation of 5 different pressure groups were detected by cell adhesion/invasion assay in vitro. Results Immediately following exposure to 15 mm Hg CO2 insufflation, the invasion of SW1116 cells decreased significantly compared to the cells before exposure. At the 0 h time point, the cells exposed to 15 mm Hg were significantly less invasive than those exposed to the other insufflation pressure (P＜0.05), and the cells exposed to 6 mm Hg were more invasive than cells exposed to the other insufflation pressure (P＜0.05). And 72 h after exposed to CO2-insufflation, the differences between the pressure groups were not significant. Conclusion CO2-insufflation induced a temporary change in the invasion capacity of cancer cells in vitro, higher pressure of CO2-insufflation inhibits the invasion potential.
Objective To investigate the influence of different pressures and duration of CO2 pneumoperitoneum on the adhesive and invasive ability of gastric cancer cells based on the expressions of adhesive and invasive molecules. Methods With an artificial CO2 pneumoperitoneum model in vitro, human gastric cancer cell lines including MKN-45, SGC-7901, and MKN-28 were exposed to CO2 in different environments: 0 mm Hg （1 mm Hg=0.133 kPa）, 9 mm Hg （2 h, 4 h）, and 15 mm Hg （2 h, 4 h）. The expressions of mRNA of E-cadherin, intercellular adhesion molecule-1 (ICAM-1), matrix metalloproteinase-2 (MMP-2), and vascular endothelial growth factor-A (VEGF-A) in the different environments were measured by RT-PCR. The expressions of protein of E-cadherin and ICAM-1 in the environments of 0 mm Hg and 15 mm Hg （4 h） were measured by FCM. Results With the increase of duration or pressure, RT-PCR showed that there was a downward trend in the expression of E-cadherin mRNA as well as there were upward trends in the expressions of ICAM-1, MMP-2, and VEGF-A mRNA; FCM showed that there was a downward trend in the expression of E-cadherin protein while the expression of ICAM-1 protein showed the opposite change. But there were no obvious differences under different environment (P＞0.05). Conclusions Under low pressure (≤15 mm Hg) and short time (≤4 h) of CO2 pneumoperitoneum, the adhesive and invasive ability of gastric cancer cells could not be affected, which means that under this environment, CO2 pneumoperitoneum will not increase the possibility of neoplasm metastasis.
Objective To summarize the research progress of CO2 pneumoperitoneum impacts on invasiveness of cancer cells. Methods Currently published experimental and clinical researches related to the effect of CO2 pneumoperitoneum on invasiveness of cancer cells were reviewed. Results CO2 pneumoperitoneum may affect the invasiveness of cancer cell through several ways， such as changing the structure and function of mesothelial cell， changing microenvironment of peritoneum， influencing the expression of oncogen， affecting the secretion of cell factor， and changing the adhesion of cancer cell. Conclusions The consequences of these alterations to cancer cell and the microenvironment are not well understood， but they may facilitate tumor invasion and implantation. Further investigations in this area are very urgent.
目的 评价舒芬太尼复合艾司洛尔对腹腔镜胆囊切除术二氧化碳气腹期间心血管反应和脑电双频指数（BIS）的影响。 方法 2010年1月－2011年12月间，选择美国麻醉医师协会分级Ⅰ～Ⅱ级择期腹腔镜胆囊切除术患者90例，随机分为芬太尼组（A组）、舒芬太尼组(B组）和舒芬太尼+艾司洛尔组（C组）。A组用芬太尼4 μg/kg，B、C组用舒芬太尼0.6 μg/kg麻醉诱导后气管插管，机械通气；C组在气腹前加用艾司洛尔。3组均常规静脉注射咪达唑仑0.1 mg/kg、丙泊酚2 mg/kg和维库溴铵0.1 mg/kg。分别记录各组在气腹前（T1）、气腹30 s（T2）、气腹5 min（T3）、气腹15 min（T4）时的收缩压、舒张压、平均动脉压、心率、血氧饱和度和BIS值。 结果 T1时C组收缩压、舒张压、心率、BIS值最低，各组间差异无统计学意义（P＞0.05）；T2、T3、T4时A组收缩压、舒张压、心率、BIS明显增加，B组有所上升，ⅢC组各时段变化不明显。A组与B组、B组与C组间差异有统计学意义（P＜0.05）。 结论 舒芬太尼复合艾司洛尔能更好地预防腹腔镜胆囊切除术二氧化碳气腹期间心血管反应和抑制BIS的增加。
Objective To explore the effects of CO2 pneumoperitoneum on pancreatic function in diabetic rabbits. Methods Forty-eight rabbits were divided into 4 groups: control group (the group of N0, n=4), the group of T0 (n=4), the group of T10 (n=20), and the group of T15 (n=20). The animal used in the groups of T0, T10 and T15 was diabetic rabbit, and the pressures of pneumoperitoneum of the three groups were 0 mm Hg, 10 mm Hg and 15 mm Hg respectively.The model of diabetic rabbits were made through intrvenous administration of Allxon. Arterial blood samples were collected before the onset of CO2 pneumoperitoneum, 0, 2, 6, 12 hours after deflation for measuring blood glucose, amylase, insulin and C-peptid. Then the rabbits were sacrificed and their pancreases were removed for measuring SOD activity and MDA content. Results After abdominal deflation, the blood glucose, amylase, insulin, C-peptid, MDA content were significantly increased （P＜0.05), and SOD activity was significantly decreased（P＜0.05). Twelve hours after abdominal deflation, the levels of blood glucose, amylase, insulin, C-peptid, MDA content returned to those before pneumoperitoneum was established in group T10. But, those in group T15 were higher （P＜0.05) than the levels before insufflation. The SOD activities in both group T10 and group T15 twelve hours after abdominal deflation were significantly different （P＜0.05） from those before pneumoperitoneum was established. There were statistically significant differences （P＜0.05) between group T10 and T15 in amylase, C-peptid, MDA content and SOD activity. Conclusion CO2 pneumoperitoneum has an certain adverse influence on pancreatic function of the diabetic rabbits. The degree of injury is correlated with the pressure of pneumoperitoneum. Pancreatic function may returned to preoperative level soon after abdominal deflation in group T10, but did not return in group T15.
ObjectiveTo investigate the changes of peritoneal macrophages function of mice with gastric cancer in the CO2 pneumoperitoneum environment, as well as its effect on the peritoneal metastasis of gastric cancer. MethodsAn orthotopic implantation model of mouse forestomach cancer was established using the 615 mouse. The mice bearing tumors were randomly divided into five groups (n=30): anesthesia alone, laparotomy, and 2, 4, and 6 mm Hg CO2 insufflation groups. Peritoneal macrophages were collected from six mice in each group and cultured. The macrophage phagocytic function on neutral red and the levels of NO and TNF-α produced by macrophages were measured after 12, 24, 48, and 72 h of culture. The remaining mice were observed after two weeks for the rate of peritoneal metastasis of forestomach cancer cells and the total weight of implanted nodules. ResultsNo death and ascites were found and the difference of weight body was not significant in all mice (Pgt;0.05). The uptake of neutral red by peritoneal macrophages and the levels of NO and TNF-α secreted by peritoneal macrophages in the laparotomy group after 12 h of culture were all significantly higher than those in other four groups (Plt;0.05). The corresponding values in the 2, 4， and 6 mm Hg CO2 insufflation groups after 12 h were all significantly lower than those in the anesthesia alone group (Plt;0.05). Among three insufflation groups, the corresponding values in the 2 mm Hg after 12 h were significantly higher than those in the 4 and 6 mm Hg CO2 insufflation group, though the difference in the two latter was not significant (Pgt;0.05). The uptake of neutral red by peritoneal macrophages and the levels of NO and TNF-α secreted by peritoneal macrophages in the 6 mm Hg CO2 insufflation group after 24 h of culture were all significantly lower than those in other four groups (Plt;0.05), while the difference in the four groups was not significant (Pgt;0.05). The uptake of neutral red by peritoneal macrophages and the levels of NO and TNF-α secreted by peritoneal macrophages after 48 h and 72 h were not significantly different in the five groups (Pgt;0.05). The rate of peritoneal metastasis of mice was significantly lower in the 6 mm Hg insufflation CO2 group (75.0%, 15/20) than that in the anesthesia alone group (100%, 24/24), Plt;0.05, but higher than other three groups(Plt;0.05), which was not different in 2 mm Hg (47.8%, 11/23), 4 mm Hg insufflation group (45.45%, 10/22) and laparotomy group (50.0%, 10/20), Pgt;0.05. The total weight of implanted nodules of mouse forestomach cancer was (1.24±0.48) g, (1.02±0.38) g, (0.96±0.33) g, (0.93±0.45) g, and (1.18±0.37) g in the anesthesia alone group, the laparotomy group, and 2, 4, and 6 mm Hg CO2 insufflation group, and the difference was not significant (Pgt;0.05). ConclusionHigh pressure (6 mm Hg) CO2 pneumoperitoneum can constantly inhibit the phagocytosis and cytokine secretion functions of peritoneal macrophages in gastric cancer-bearing mice and promote peritoneal implantation of gastric cancer.
With the extensive application of laparoscopy in clinical surgery, the advantages of laparoscopic surgery such as less intraoperative bleeding, small and beautiful incision, and rapid postoperative recovery become increasingly prominent. However, prolonged use of carbon dioxide (CO2) pneumoperitoneum or high CO2 pneumoperitoneum pressure during laparoscopic surgery may cause subcutaneous emphysema and hypercapnia, in severe cases which may affect the quality of recovery and prognosis of patients. The use of a protective ventilation strategy during laparoscopic surgery under general anesthesia, a mechanical ventilation model of controlled hyperventilation, can reduce or avoid the effects of hypercapnia caused by prolonged CO2 pneumoperitoneum or high CO2 pneumoperitoneum pressure. This article reviews the effects of laparoscopic CO2 pneumoperitoneum on patients, the application of controlled hyperventilation in laparoscopic surgery under general anesthesia and the effects of controlled hyperventilation on patients. The aim is to provide a theoretical basis for the safe and effective application of controlled hyperventilation in laparoscopic surgery.
Objective To investigate the effect of CO2 pneumoperitoneum on the tumor cell port site implantation in laparoscopic surgery. Methods Male SpraqueDawley rats were intraperitoneally injected with gastric cancer cells (cell line SGC-7901). Continuous CO2 pneumo of 15 mm Hg or 30 mm Hg were established for 5 mins, 60 mins, 120 mins and 180 mins with the injection of different concentrations of tumor cells (104/ml, 106/ml respectively). Several samples of peritoneal washing served as positive control. All collecting dishes were incubated at 37℃ with 5% CO2 concentration for one week and then examined for the presence of tumor cell under microscope. Results After one week of incubation, some of the dishes with continuous flow of CO2 gas (5 L/min) at pneumo 30 mm Hg for 60 mins or longer demonstrated tumor growth, and all peritoneal washing samples showed tumor growth, while other dishes showed negative. Conclusion The research suggests that gastric cancer cells can cause port site implantation and the concentration of tumor cells, pneumoperitoneum pressure and duration may affect the occurrence of port site implantation. It may help to find a suitable way to prevent the port site implantation in operations.
Objective To investigate the way of closed establishment of pneumoperitoneum（CEPP） in patients with peritoneal cavity adhesion in laparoscopy, and to sum up the successful experience and the lesson of visceral injury. Methods CEPP experiences of 1 046 cases of peritoneal adhesion were retrospective analysed in 6 600 cases laparoscopy in our unit from September 1991 to September 1999.The difficulty of establishment of pneumoperitoneum was classified as real difficulty in establishment of pneumoperitonum (RDEPP) and false difficulty in establishment of pneumoperitonum (FDEPPD). RDEPP was due to Veress needle penetrating into viscera or peritoneal extensive adhesion in peritoneal cavity, and CO2 air flowing into difficulty. FDEPP was due to veress needle penetrating into extraperitoneum fat, round hepatic ligament or larger messentry. The formal situation required conversion to open laparotomy, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle direction or penetrating depth in second penetration. Results In this group 1 046 patients, 1 028 cases (98.3%) had been established pneumoperitoneum successfully by way of CEPP, 6 cases of RDEPP and 12 cases of FDEPP required open laparotomy. No complication related to CEPP had been found in this group except two cases visceral injury cured by laparotomy and repairment. Conclusion CEPP in patients with peritoneal adhesion is safe and feasible in laparoscopy. The main reason of CEPP failure is regarding FDEPP as RDEPP due to deficiency of experience and confidence of laparoscopist.
目的探讨低压辅助悬吊式腹腔镜在合并心血管疾病患者行腹腔镜胆囊切除术（LC）中的应用价值和安全性。 方法回顾性分析2007年1月至2010年10月期间，通渭县中医院普外科以及甘肃省人民医院普外科收治的132例合并心血管疾病的急、慢性胆囊炎或胆囊结石患者的临床资料。 结果132例患者均进行了低压辅助悬吊式LC，手术均顺利完成，成功率为100%，无中转开腹，患者术中、术后生命体征正常。 结论低压辅助悬吊式腹腔镜技术在合并心血管疾病患者中是安全、可行的。