二氧化碳气腹腹腔镜手术对人体腹膜形态学的影响

目的 探讨二氧化碳（CO2）气腹腹腔镜手术对人体腹膜形态学的影响。方法 对40例子宫肌瘤或单纯卵巢囊肿患者（排除腹膜炎症）随机分别进行腹腔镜手术和开腹手术，于手术0、30、60、90、120min分别采集壁层腹膜，对其进行扫描电镜（SEM）观察腹膜间皮细胞形态学变化。结果 开腹组开腹后0min间皮细胞未见明显变化，细胞形态正常，基底膜完整，60min仍然如此，90min细胞间连接偶可见断裂，120min稍明显。腹腔镜组充气后0min可见问皮细胞迅速肿胀，30min仅见间皮细胞肿胀，偶可见细胞间隙，60min可见腹膜间皮细胞间连接断裂，深到基底膜下，基底膜连续性中断，故而裸露，细胞间隙可见，90min和120min更明显，细胞间隙见少量淋巴细胞和巨噬细胞。结论 与开腹手术相比，CO2气腹腹腔镜手术可使腹膜形态学发生明显变化，其变化程度与充气时间有关。

Effect of carbon dioxide pneumoperitoneum during laparoscopic surgery on morphology of peritoneum

Objective To investigate the influence of carbon dioxide (CO_2) pneumoperitoneum during laparoscopic surgery on morphology of peritoneum. Methods Forty patients with myoma of uterus or simple ovarian cyst excluding peritonitis were randomly divided into 2 equal groups to undergo laparoscopic surgery with CO_2 pneumoperitoneum or laparotomy respectively. Specimens of parietal peritoneum were obtained at different time points, 0, 30, 90, and 120 min after the beginning of observation, i.e. e, insufflation or opening of the peritoneal cavity, to undergo transmission electron microscopy and scanning electron microscopy to observe the morphological changes of mesothelial cells. Results In the laparotomy group, up to the time point of 60 min, there was no marked change of mesothelial cells. Intercellular cleft were occasionally found since 90 min and became significant 120 min after. However, in the CO_2 pneumoperitoneum group bulging up of mesothelial cells was evident immediately at the time of filling of CO_2, intercellular spaces could be found 30 min later, 60 min later intercellular cleft deep to the underlying basement membrane could be seen and the basement membrane lost its continuity and became uncovered, and 120 min later such changes became more significant and a small amount of lymphocytes and macrophages were found in the intercellular clefts. Conclusion Carbon dioxide pneumoperitoneum during laparoscopic surgery causes significant morphological changes in the peritoneum duration of insufflation dependently.