自1987年Mouret完成世界首例腹腔镜胆囊切除术以来，随着外科医生手术技术的不断提高和腹腔镜器械的逐渐改进，腹腔镜微创技术的应用范围越来越广泛，以腹腔镜为代表的微创外科已经成为21世纪外科发展的方向之一，其对胃肠道恶性肿瘤根治的可行性和手术安全性已经得到认可。已有多项RCT研究显示，腹腔镜结直肠癌手术与开腹手术具有相当的近、远期疗效，美国结直肠癌外科医师协会已将其列为治疗结直肠癌的标准手术方式之一。近年来，腹腔镜在胃癌根治术中的应用已逐渐由早期胃癌扩展到进展期胃癌，并取得了与开腹手术相当的近、中期疗效。但是人们对CO2 气腹是否有利于胃肠道肿瘤的侵袭、转移一直心存疑虑，随之一些有关腹腔镜技术中不同种类、不同压力的气腹与胃肠道肿瘤侵袭、转移关系的研究报道相继出现,不同学者报道结果有较大差异，有些学者认为CO2气腹有利于胃肠道肿瘤的侵袭、转移; 而有些学者却认为CO2气腹对胃肠道肿瘤的侵袭、转移无显著影响。..................
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.
【摘要】目的 探讨心功能Ⅱ级患者在低气腹压下行腹腔镜胆囊切除术的可能性。 方法 总结我院2003年7月至2004年7月间收治的18例心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术的临床资料。 结果 18例心功能Ⅱ级患者中17例完成腹腔镜胆囊切除，1例中转开腹。 结论 心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术是可行的。
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.
【摘要】 目的 研究不同压力二氧化碳（CO2）气腹对糖代谢的影响。 方法 18只雌性健康新西兰大白兔按CO2气腹压力随机均分为气腹压0 mm Hg （1 mm Hg=0.133 kPa）（Ⅰ组）、气腹压10 mm Hg（Ⅱ组）和气腹压15 mm Hg（Ⅲ组）。每组兔均在不同的压力下接受气腹1 h。在CO2气腹前（T0）、气腹后30 min （T1）、气腹后60 min （T2） 测定动脉血气分析值、血糖（Glu）、胰岛素（Ins）和胰高糖素（Gln）。 结果 气腹后30 min 、60 min，Ⅱ组与Ⅰ组比较，PaCO2、Glu 、Gln增加（Plt;0.05），pH值和Ins下降（Plt;0.05），Ⅲ组各参数变化更为显著（Plt;0.01）。结论 CO2气腹后机体可能处于较强烈的应激状态，导致血糖升高。【Abstract】 Objective To study effects of different intraabdominal pressure of carbon dioxide (CO2) pneumoperitoneum on blood glucose level in rabbits. Methods Eighteen female healthy rabbits weighed 2.1-3.3 kg were randomly divided into three groups equally based on pneumoperitoneum pressure: 0 mm Hg (1 mm Hg=0.133 kPa) group (groupⅠ),10 mm Hg group (groupⅡ) and 15 mm Hg (groupⅢ). Each group received 1h pneumoperitoneum under diffent pressure. Blood samples were taken before CO2 pneumoperitoneum, at 30 and 60 minutes after pneumoperitoneum for the measure-ments of arterial blood gas, blood glucose (Glu), insulin (Ins) and glucone (Gln). Results After pneumoperitoneum at 30 and 60 minutes, compared with groupⅠ, PaCO2,Glu and Gln were significantly raised in groupⅡ(Plt;0.05), pH and Ins were markedly decreased (Plt;0.05). Even more significant changes were observed in group Ⅲ(Plt;0.01). Conclusion After CO2 pneumoperitoneum, body is in a relatively b stress, so blood glucose is decreased.
【Abstract】ObjectiveTo investigate the effects of CO2 pneumoperitoneum on blood flow of carotid arteries in atherosclerosis rabbits.MethodsFifty Japan white rabbits were randomly divided into control group and three atherosclerosis groups. In atherosclerosis group, the rabbits were randomly subjected to CO2 pneumoperitoneum with an intraabdominal pressure of 0 mm Hg, 10 mm Hg or 15 mm Hg for 2 hours, after the model were created by feeding the rabbits with high fatty diet. The blood flow of the common carotid arteries were measured by electromagnetic blood flowmeter. Artery blood samples were collected for blood gas analysis at 30 minute intervals. ResultsHigher insufflation pressures and longer duration of CO2 pneumoperitoneum were associated with greater increase in blood flow of common carotid arteries. Compared with those in control group and atherosclerosis group with 0 mm Hg CO2 pneumoperitoneum, there were statistically significant increases in blood flow of the common carotid arteries during CO2 pneumoperitoneum in 10 mm Hg and 15 mm Hg pneumoperitoneum group, the changes in 15 mm Hg pneumoperitoneum group were more significant than those in 10 mm Hg pneumoperitoneum group (Plt;0.05). When compared with the blood flow before insufflation, those in 10 mm Hg and 15 mm Hg pneumoperitoneum group also increased significantly during CO2 pneumoperitoneum, even at 30 minute after desufflation (Plt;0.05). However, those in control group and 0 mm Hg pneumoperitoneum group did not change significantly (Pgt;0.05). There were significant decrease in pH and significant increase in PCO2 in both 10 mm Hg and 15 mm Hg groups, when compared with presufflation values or those in control group and 0 mm Hg pneumoperitoneum group(Plt;0.05). The changes in pH and PCO2, however, were no significant at any time point in control group and 0 mm Hg pneumoperitoneum group (Pgt;0.05). HCO3- did not change significantly in either group(Pgt;0.05).ConclusionUnder atherosclerosis conditions, CO2 pneumoperitoneum has an adverse influence on the blood flow of the common carotid arteries which may be associated with increased intrabdominal pressure,absorbed CO2 gas.
目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中不同CO2气腹压力对患者肝功能、动脉血气及对颈、肩痛的影响。方法 选择行择期LC术患者120例，采用随机数字表法，按住院先后顺序对应入组，随机均分为气腹压力10mmHg （1 mm Hg=0.133kPa）组、12mmHg组及14mmHg组3组；对比分析3组患者手术后肝功能、血气指标以及术后当天、第1和第2天恶心、呕吐及颈肩部疼痛的发生率。结果 3组患者术前各参数组间比较差异均无统计学意义（P＞0.05）。术后肝功能及血气分析指标的改变3组间的差异有统计学意义（P＜0.05），气腹压力越大，其术后AST、ALT及TBIL水平升高越明显，而pH及PO2的下降越明显，PCO2的升高也越明显；术后患者颈、肩痛及恶心呕吐发生率3组间比较差异也有统计学意义（P＜0.05），气腹压力越大，术后颈、肩痛及恶心呕吐发生率越高。结论 CO2气腹压力对术后肝功能及动脉血气指标的改变以及术后颈、肩痛和恶心呕吐发生率有明显影响。
ObjectiveTo investigate the clinical value of veress needle with thread for laparoscopic high ligation of hernia sac in children. MethodsThe clinical data of 56 cases of pediatric inguinal hernia using laparoscopic high ligation of hernia sac with veress needle from May 2013 to May 2014 were analyzed retrospectively. ResultsAll patients were successfully carried out operation by laparoscopic high ligation of hernia sac.Forty-one cases underwent unilateral surgery, and operative time was 6-18 min (mean 9.6 min); 15 cases underwent bilateral surgery, and operative time was 10-32 min (mean 14.3 min).Nine cases of contralateral recessive hernia were found and ligated during operation.There was no complications, such as scrotal edema, scrotal gas or incision infection after operation, and all patients were discharged in l-2 days after operation.No recurrence or testicular dysplasia was found during 3 to 15 months (mean 10.8 months) follow-up. ConclusionsThere are many advantages in laparoscopic high ligation of hernia sac with veress needle, such as less damage, hidden incision, faster recovery, shorter hospital stay, simple operation, and better efficacy.We can find contralateral recessive hernia during operation and avoid second surgery with high clinical value, therefore it is worthy of clinical application.
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 study whether carbon dioxide used to establish pneumoperitoneum has an influence on port-site and intraperitoneal implantation and metastasis of tumor cells. Methods R15 hepatic cancer cells were injected into 30 Wistar rats’ peritoneal cavities 1 hour before operation, then the 30 Wistar rats were randomly divided into 3 groups: gasless group, helium group and carbon dioxide group. The suspension was exposed to the gas environment for 2 hours, all animals were killed after 28 days and the port-site and intraperitoneal implantation and metastasis of tumor cells were examined. Results On port-site, intestinal serous coat, mesentery, greater omentum and diaphragm, the weights of tumor cells, in carbon dioxide group were (326.7±230.3) mg， （626.2±215.9） mg，（476.2±204.8） mg，（2 536.5±906.7） mg and （384.5±149.9） mg respectively； in helium group were (235.6±107.3) mg， （414.2±148.4） mg, （261.8±92.6） mg, （1 633.4±247.3） mg and（220.0±57.9） mg； in gasless group were (145.0±42.4) mg， （221.5±108.2） mg， （212.5±109.6） mg, （797.5±335.9） mg and 113.0 mg.The weights of carbon dioxide group showed a significant increase, compared with helium group and gasless group (P＜0.05). The weights of helium group were greater than gasless group，but there was no significance in statistics (Pgt;0.05). Conclusion The insufflation of carbon dioxide promotes intraperitoneal tumor implantation and growth compared with helium and gaslessness in a rat model.