Experimental assessment of tumor growth and dissemination of a microscopic peritoneal carcinomatosis after CO2 peritoneal insufflation or laparotomy

BACKGROUND: Based on clinical observations and previous animal studies, laparoscopic surgery for malignant disease is regarded as controversial. We used a rat model to measure and compare the tumor growth, proliferation, and dissemination of a microscopic peritoneal carcinomatosis after CO(2) intraperitoneal insufflation or laparotomy. METHODS: Peritoneal carcinomatosis was induced in three groups of 27 BD IX rats each with intraperitoneal injections of 106 DHD/K12 cells, an aneuploid tumor cell line. At 48 h after tumor cell injection, the animals were randomly divided into three groups to undergo different types of intervention. All animals were anesthetized for 20 min (Halothane). The control group had no surgical intervention (group C), group I had CO(2) insufflation (7 mmHg),and group L had a midline laparotomy (5-cm). Neither bowel manipulation nor any other traumatic action was performed. Two weeks later, the rats were killed and the incidence, type, and dissemination of carcinomatosis were evaluated. We also measured the tumor's weight. Malignant omentum was sampled for flow cytometry analysis (DNA ploidy, S-phase fraction). RESULTS: The incidence of carcinomatosis did not differ among the groups. The mean score of macroscopic characteristics of the carcinomatosis was 2.8 +/- 1.9 in group L, 2.9 +/- 1.9 in group I, and 3 +/- 1.9 in group C (NS). The location of the implants did not differ, except for parietal peritoneum location, which was more frequent in group L (p < 0.01). The tumor weight was 4.96 g +/- 3.2 in group L, 5.55 g +/- 3.2 in group C, and 5.75 g +/- 3.4 in group I (NS). The percentage of aneuploid cells and S-phase fraction did not differ statistically among the groups. Conclusion: These results indicate that CO(2) insufflation does not cause more effects than laparotomy when tumors cells are present before the beginning of the surgery. Further studies are needed to determine the influence of other steps in laparoscopic surgery on tumor growth and dissemination.     

腹腔镜在诊治原发性腹膜炎中的应用

目的:探讨腹腔镜在诊治原发性腹膜炎中的应用价值。方法:将1995年2月至2001年1月应用腹腔镜诊治的原发性腹膜炎11例与1995年以前行开腹手术的24例在手术时间、住院天数、切口感染率方面进行对照。结果:腹腔镜手术组11例的手术时间为(39.9±7.6)min,住院天数(7.9±2.9)d,切口感染率9.1％(1/11);开腹手术组24例的手术时间为(71.0±12.0)min,住院天数(14.0±3.9)d。切口感染率25.0％(6/24)。两组手术时间及住院天数差异有显著性(P<0.01),且腹腔镜组切口感染率低。结论:腹腔镜手术诊治原发性腹膜炎安全、有效、优于开腹手术。     

Effect of CO2 insufflation on bacteremia and bacterial translocation in an animal model of peritonitis

Background: The widespread adoption of the laparoscopic approach has created some concern over the potential for increased risk of bacteremia and sepsis due to increased intraabdominal pressure in patients with intraabdominal infection and peritonitis. This study examines the effect of the CO₂ pneumoperitoneum on bacteremia and bacterial translocation. Methods: New Zealand white rabbits were assigned into three groups of 10 animals. In group 1, 100 ml of sterile saline was infused into the peritoneal cavity under 10 mmHg CO₂ insufflation for 1 h. Group 2 received 100 ml of saline containing 10⁹ CFU/ml (colony-forming units) E. coli strain 0163 and 10 mmHg CO₂ insufflation for 1 h. Group 3 received an identical bacterial inoculum, followed by a 10-cm midline laparotomy. Blood samples were taken for culture by cardiac puncture at various intervals during the experiment. At 6 h after being subjected to the experimental procedures, the rabbits were killed and their organs were cultured quantitatively for translocating bacteria. Results: In group 1, neither blood nor organ cultures were positive, whereas in group 2 all blood cultures became positive in 1 h, and intraperitoneally infused bacteria translocated to the lung and kidney in all rabbits. In group 3, blood cultures became positive in 1 h, all but two of the rabbits had translocated bacteria in their lungs, and kidney samples from two of the rabbits were culture-positive. Conclusions: Our results indicate that both CO₂ pneumoperitoneum and laparotomy increase the incidence of bacterial translocation from the peritoneal cavity into the bloodstream. Thus, the risk of translocation to extraperitoneal organs such as lung and kidney is increased significantly by laparoscopy. Therefore, laparoscopic surgery should be avoided or used cautiously in the setting of acute peritonitis.     

Effects of laparoscopic vs laparotomy treatment of E. coli peritonitis on hemodynamic responses in a porcine model

Background: Laparoscopic surgery is being used now for increasingly diverse clinical applications, including diagnosis and treatment of appendicitis and bacterial peritonitis. However, some concerns and controversies exist regarding the effectiveness of laparoscopic irrigation of the abdominal cavity compared with that achieved during laparotomy. Of no less importance is concern that establishing a CO₂ pneumoperitoneum in patients with cardiopulmonary insufficiency or endotoxemic shock may compromise hemodynamic function. The objective of this randomized, controlled study was to determine the effects of laparoscopic versus laparotomy intervention on hemodynamic and outcome measurements using a porcine model of Escherichia coli peritonitis. Methods: For this study, 24 specific pathogen-free Hanford pigs underwent surgical placement of carotid, Swan-Ganz, and peritoneal catheters. After a 24-h recovery period, one subset of pigs (n= 12) received a bolus infusion of 9 × 10⁸ CFU/kg E. coli intraperitoneally (septic) and intravenous fluid resuscitation. The remaining 12 pigs were not challenged with E. coli (control). Twenty-four hours later, all 24 pigs underwent either laparoscopic or open peritoneal irrigation with saline, then were reevaluated 48 h after surgical intervention. Standard cardiopulmonary, hematologic, and bacteriologic assessments were obtained both perioperatively and 48 h after surgical intervention. Results: Pigs given E. coli exhibited significantly elevated heart rates and core temperatures and decreased O₂ saturation during the initial 6 h. Within 24 h, these pigs exhibited respiratory alkalosis, altered blood leukocyte profiles, and E. coli–infected peritoneal fluid. Random blood samples from the septic pigs tested negative for E. coli. Mean pulmonary artery and capillary wedge pressures were lower (p < 0.05) in septic than in control pigs before and after surgical intervention. Septic pigs that underwent laparoscopy had significantly lower (p < 0.05) arterial pH and higher arterial pCO₂ levels than septic pigs after laparotomy. Other cardiopulmonary responses were similar irrespective of the surgical modality used. One of six septic pigs from each surgical group still had E. coli growth in its peritoneal fluid 48 h after surgical intervention. Conclusion: Laparoscopic intervention demonstrated effectiveness equal to that of laparotomy for treating acute E. coli peritonitis in pigs without septic shock. Received: 26 June 1998/Accepted: 12 January 1999     

Effect of abdominal insufflation on bacterial growth in experimental peritonitis

BACKGROUND: Perforated appendicitis can be treated laparoscopically, but this approach is associated with a higher rate of intra-abdominal abscess. Pneumoperitoneum impairs the clearance of bacteria from the peritoneal cavity in experimental models of peritonitis. The aim of this study was to investigate the effects of intra-abdominal gas insufflation on bacterial growth in a rat model. MATERIALS AND METHODS: The effects of intraperitoneal insufflation with different gases and a gasless model on bacterial proliferation in a setting of Escherichia coli-induced experimental peritonitis were studied in a rat model. Saline (0.25 mL) was given intraperitoneally to six Wistar male rats as the sham group. Escherichia coli (1.5 x 10(9) cfu/mL per kilogram) was injected intraperitoneally into to 24 rats. Microorganism counts were taken after 8 hours, and rats were divided into three groups: group 1, CO2 insufflation; group 2, N2O insufflation; and group 3, no insufflation. Microorganism counts were repeated 8 hours after the procedure (at 16 hours postinjection). RESULTS: The difference in microorganism counts between 8 and 16 hours were significant in the CO2 and N2O insufflation groups (P < 0.05) but not in the group without pneumoperitoneum. CONCLUSIONS: Abdominal insufflation may promote intra-abdominal bacterial growth or decrease intra-abdominal bacterial clearance.     

Effect of carbon dioxide pneumoperitoneum on bacteremia and severity of peritonitis in an experimental model

Background: Laparoscopy is increasingly used in conditions complicated by peritonitis. A theoretical concern is that carbon dioxide pneumoperitoneum may increase bacteremia. Method: In 60 rats peritonitis was induced by cecostomy. Animals were randomly allocated to pneumoperitoneum (PP) and control groups. Blood cultures and intraabdominal swabs were assessed. A peritonitis severity score (PSS) was computed based on histology from peritoneal biopsy. Results: One hour after cecostomy neither in abdominal swabs nor in blood samples bacteria were reproduced in PP and control groups. Three hours after cecostomy the frequency of positive blood cultures was 80% and 20% in PP and control groups, respectively (p < 0.0001). Six hours after cecostomy the frequency of positive blood cultures was 100% in each group (p > 0.05). One hour after cecostomy the mean peritoneal severity score was significantly higher in the PP group than in the control group, but there was not any significant difference between groups 3 and 6 h after cecostomy. The mean peritoneal severity scores were found to be significantly increased with time when the PP groups compared with each other. Conclusion: In rats, pneumoperitoneum can't cause a more severe peritonitis but it does induce an increase in the rate of bacteremia within the early 6-h period of peritonitis. Received: 14 April 1997/Received: 18 September 1997     

腹腔镜手术中突然无CO_2的应急处理

目的:探讨腹腔镜术中突然无CO2时使用自行设计的应急腹腔充气装置向腹腔充气继续施行手术的可行性。方法:使用本装置建立空气气腹与常规CO2气腹行腹腔镜动物实验,观察建立的手术空间及使用钩状电极时的火花情况,监测动物在麻醉、充气、手术过程中脉搏(pulse,P)、动脉血氧饱和度(SpO2)的变化及术后生存情况,取得一定经验后应用于临床。结果:动物在麻醉、术中、术后半小时P、SpO2的变化曲线一致,能建立足够的手术空间,使用钩状电极切割时无爆炸,火花不明显,术后动物生存良好。使用本装置完成1例腹腔镜异位妊娠取胚术,手术顺利,术中血压(blood pressure,BP)、P、SpO2平稳,术后6h患者BP、P、SpO2正常。结论:腹腔镜术中突然无CO2时用自行设计的应急腹腔充气装置是安全的,具有一定的实用性与可操作性。     

半开放置鞘气腹法在腹部手术史患者腹腔镜术中的应用

目的　探讨腹腔镜术半开放置鞘气腹法对有腹部手术史患者建立气腹的可行性及操作方法。　方法　回顾分析 1994年 10月～ 2 0 0 2年 1月 2 10 0例腹腔镜术中 117例有腹部手术史患者半开放置鞘气腹法 115例成功的经验及 2例失败的教训。　结果　 117例中 115例成功建立气腹 ,1例胃大部切除术后胆囊结石反复穿刺导致空肠穿孔 ,腹腔镜下行空肠修补术和腹腔镜胆囊切除术 ,1例剖宫产术后因腹腔内广泛粘连气体膨胀困难而中转开腹。本组半开放置鞘气腹法成功率 98 3 % (115 / 117)。　结论　有腹部手术史患者半开放置鞘气腹法建立气腹安全可行 ,融合闭合法及开放法的优点 ,操作简便。     

Cytokine response in the postoperative period after surgical treatment of benign adnexal masses: comparison between laparoscopy and laparotomy

Background Cytokines are the main mediators of the inflammation and the response to trauma. The purpose of the present study was the comparative assessment in sera of patients with benign adnexal masses treated by laparoscopy or laparotomy of the following proinflammatory and anti-inflammatory cytokines: interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-alpha (TNF-α), and IL-10 in the early postoperative period. Methods A total of 40 patients with benign adnexal masses were studied; 25 of whom underwent laparoscopy and 15, laparotomy. Blood serum concentration of IL-1β, IL-6, IL-8, TNF-α, and IL-10 were measured by commercially available ELISA assays before and 4 h, 24 h, and 48 h after the operation. Results Concentrations of IL-6 were significantly increased in both groups at 4 h, 24 h, and 48 h after the surgery; levels of IL-10 showed a significant increase 4 h and 24 h after the operation; an increase in IL-1β levels was observed only after laparotomy; no significant variations were observed in serum levels of IL-8; the postoperative increase of IL-1β, IL-6, and IL-10 levels was more pronounced in patients undergoing laparotomy than in those treated laparoscopically; length of the surgical procedure, amount of CO₂ used, tumor diameter, age, and body mass index (BMI) of the patients did not influence the postoperative patterns of the studied cytokines. Conclusions Systemic cytokine response after operations for benign adnexal masses depends on the degree of the surgical trauma, and is less pronounced in patients undergoing laparoscopy.     

Increased transperitoneal bacterial translocation in laparoscopic surgery

Background: The indications for laparoscopic surgery have expanded to include diseases possibly associated with peritonitis such as appendicitis, perforated peptic ulcers, and diverticulitis. The safety of carbon dioxide (CO₂) pneumoperitoneum in the presence of peritonitis has not been proved. Our previous investigations demonstrated increased bacteremia associated with CO₂ insufflation. In effort to clarify the relative effects of intraabdominal pressure and type of gas, this study was designed to measure bacterial translocation with different gases at different pressures of pneumoperitoneum. Methods: For this study, 110 rats were given intraperitoneal bacterial innoculations with Escherichia coli and equally divided into five groups of 20 animals each. The study groups included a control group with no pneumoperitoneum administered (n = 30), insufflation at a commonly used pressure of 14 mmHg with helium (n = 20) and CO₂ (n = 20), and low insufflation at 3 mmHg with helium (n = 20) and CO₂ (n = 20) in an effort to minimize influences related to pressure. Blood cultures were checked at 15-min intervals for the first 45 min, then hourly thereafter for a total of 165 min after peritoneal inoculation with 2 × 10⁷ E. coli. Results: There is increased risk of bacterial translocation in comparing groups that underwent pneumoperitoneum with those that did not in the rat peritonitis model. Furthermore, these findings are dependent on the presence or absence of gas, but not necessarily on the type of gas used for insufflation. In the low-pressure groups of both gases (helium and CO₂), bacterial translocation was significantly increased, as compared with the control group. Low pressure also was associated with increased bacterial translocation, as compared with high pressure, but beyond 30 min of insufflation, no significant differences were apparent. Conclusions: The risk of bacterial translocation in the E. coli rat peritonitis model is increased with insufflation using CO₂ or helium, and this effect is more significant at lower pressures (3 mmHg) than at higher pressures (14 mmHg). However, no clinically applicable conclusions regarding the relative effects from type of gas or insufflation pressures could be confirmed.     

Prevention of intraperitoneal adhesion formation using beta-glucan after ileocolic anastomosis in a rat bacterial peritonitis model

BACKGROUND: To investigate the effects of beta-glucan on intraabdominal abscess and adhesion formation after ileocolic anastomosis in a rat bacterial peritonitis model. METHODS: Sixty male Wistar rats were used in this study. Bacterial peritonitis was induced by performing a cecal ligation and puncture (CLP). On the first day, abdomen was reopened and peritoneal fluid samples were taken for microbiological examination. Thereafter, cecum was resected and ileocolic anastomosis was made. Group 1 rats were given 1 mL of normal saline as a placebo. Group 2 and group 3 rats were given beta-D-glucan 2 mg/kg by intramuscularly; 1 mg of beta-1,3-D-glucanase was administered to group 3 rats just after the use of beta-D-glucan. Half of each group were killed at day 7 and at day 21, respectively. Adhesions were scored and the presence of intraabdominal abscesses was noted. RESULTS: One day after CLP, microbiological examination showed polymicrobial bacterial peritonitis. Five (8%) of the 60 animals died owing to sepsis. One week after CLP, in two rats in each group developed abscess formation. Three weeks after CLP, abscess formation was observed in only one rat in each group. The rats treated with the beta-glucan had significantly lower adhesion scores than did the saline-treated rats (P = 0.008 at one week; P = 0.001 at 3 weeks). Administration of beta-glucanase inhibited beta-glucan activity and resulted in more adhesions (P = 0.022 at 1 week; P = 0.006 at 3 weeks). CONCLUSIONS: Although the use of beta-glucan after ileocolic anastomosis in rats with experimentally developed intraabdominal sepsis does not have any significantly effect on mortality and abscess formation, beta-glucan is capable of reducing the frequency of adhesion. This effect of beta-glucan has been prevented with beta-glucanase     

Effect of a pneumoperitoneum on the extent and severity of peritonitis induced by gastric ulcer perforation in the rat

Laparoscopic surgical repair of perforated gastroduodenal ulcer is technically feasible. To study the effect of a pneumoperitoneum on the extent and severity of peritonitis this animal study was devised. In rats gastric ulceration was induced by instillation of ethanol (50%, 2 ml) and followed by gastrotomy to simulate perforation. Animals were randomly allocated to pneumoperitoneum (PP) and control groups. In PP groups CO₂ was insufflated intraperitoneally 6, 9, 12, and 24 h after gastrotomy. In controls the abdomen was only punctured. Animals were sacrificed 5 h after the end of PP or abdominal puncture. Blood cultures and intraabdominal swabs were assessed. A peritonitis severity score (PSS) based on histologies from peritoneum, liver, left kidney, spleen, and first jejunal loop was estimated. Six and 9 h after gastrotomy no significant differences between the PP and control groups were observed; 12 h after gastrotomy cultures of blood samples and abdominal swabs were positive in 67% and 75% in the PP group compared to 42% (P<0.05), and 42% (P<0.05) in controls. The mean PSS was 20.8 (standard deviation [SD] 2.2) in the PP group compared to 11.3 (1.5) (P<0.01) in controls; 24 h after gastrotomy cultures of blood samples and abdominal swabs were positive in 83% and 100% in the PP group compared to 42% (P<0.05) and 50% (P<0.01) in controls. The mean PSS was 22.1 (1.5) in the PP group compared to 11.8 (2.4) (P<0.01) in the controls. In rats a pneumoperitoneum aggravates the extent and severity of peritonitis, when the interval between gastric ulcer perforation and pneumoperitoneum lasts 12 h or longer.Presented at the annual meeting of the Society of American Gastro-intestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

腹腔镜技术诊断结核性腹膜炎的应用价值

目的:探讨腹腔镜技术诊断结核性腹膜炎有效性及安全性.方法:回顾分析2006年1月至2011年1月为36例疑为结核性腹膜炎的患者行腹腔镜探查术的临床资料,并收集临床数据、腹水成分、组织病理活检进行临床评估.结果:32例患者经组织学活检及抗酸杆菌培养确诊为结核性腹膜炎,其中19例以腹腔粘连为临床表现,13例表现为腹水,腹腔镜确诊率为88 9％.术后无并发症发生,均经规范抗结核治疗治愈.结论:腹腔镜探查术是诊断结核性腹膜炎安全、准确的方法.     

Does laparoscopy increase bacteremia and endotoxemia in a peritonitis model?

Background: Laparoscopy is increasingly used in patients with intraabdominal bacterial infection although pneumoperitoneum may increase bacteremia by elevated intraabdominal pressure. Methods: The influence of laparotomy and laparoscopy on bacteremia, endotoxemia, and postoperative abscess formation was investigated in a rat model. Rats received intraperitoneally a standardized fecal inoculum and underwent laparotomy (n= 20), or laparoscopy (n= 20), or no further manipulation in the control group (n= 20). Results: Bacteremia and endotoxemia were higher after laparotomy and laparoscopy compared to the control group (p= 0.01) 1 h after intervention. One hour after intervention, aerobic and anaerobic bacterial species were detected in the laparotomy group while only anaerobic bacteria were found in the other two groups. Although bacteremia and endotoxemia did not differ among the three groups after 1 week, the mean number of intraperitoneal abscesses was significantly higher (p < 0.05) after laparotomy (n= 10) compared with laparoscopy (n= 6) and control group (n= 5). Conclusion: Laparoscopy does not increase bacteremia and intraperitoneal abscess formation compared to laparotomy in an animal model of peritonitis. Received: 28 May 1996/Accepted: 25 July 1996     

Enhancement of port site metastasis by hyaluronic acid under CO2 pneumoperitoneum in a murine model

Background

The mechanism underlying the development and progression of port site metastasis after laparoscopic surgery for cancer is still not understood. Hyaluronic acid secreted from mesothelial cells is thought to be a key factor that causes adhesion between cancer cells and mesothelial cells. Using a murine model of carbon dioxide (CO₂) pneumoperitoneum, we evaluated the effect of exogenous hyaluronic acid on port site metastasis.

Methods

BALB/c mice were injected with 5×10⁶ human gastric carcinoma (MKN45) cells and divided into four groups treated with or without hyaluronic acid and with or without pneumoperitoneum. Three weeks later, the frequency and weight of port site metastases were determined. The effects of hyaluronic acid on tumorigenicity and tumor with MKN45 cells.

Results

Port site metastasis occurred significantly less frequently in the pneumoperitoneum-only group than in the pneumoperitoneum-with-hyaluronic-acid group (75% vs 100%, p<0.05). The port site metastatic tumor weighed significantly less in the control group (anesthesia only) than in the hyaluronic acid group (89±17 vs 288±35mg, p<0.05); it also weighed less in the pneumoperitoneum-only group than in the pneumoperitoneum-with-hyaluronic-acid group (87±24 vs 298±51 mg, p<0.05). The frequency and weight of tumors in the subcutaneous tissue were not significantly different between groups with or without hyaluronic acid injection (95% vs 90%, 331±128 vs 322±115 mg).

Conclusions

Under CO₂ pneumoperitoneum, exogenous hyaluronic acid increased the frequency and weight of port site metastasis in a murine model. Hyaluronic acid secreted from mesothelial cells may be associated with the formation of port site metastasis after laparoscopic surgery for cancer under pneumoperitoneum.     

腹腔镜技术在腹部闭合性损伤中的应用

目的探讨腹腔镜技术在腹部闭合性损伤的治疗中的应用效果。方法选取2015年1月至2015年5月收治的闭合性腹部损伤患者86例,根据治疗方式分为腹腔镜手术组(64例)和中转开腹手术组(22例)。采用SPSS 20.0进行分析处理,术后并发症发生率采用χ2检验;手术时间、术中出血量、住院时间和住院费用采用(x珋±s)表示并行t检验。以P0.05为差异有统计学意义。结果腹腔镜手术组手术时间、术中出血量、住院时间、住院费用均显著低于中转开腹手术组(t=6.531,t=2.378,t=2.356,t=8.569,P0.05或P0.01)。腹腔镜手术组术后并发症发生率3.13%(2/64)显著低于中转开腹手术组36.36%(8/22)(χ2=9.565,P0.01);出院时,腹腔镜手术组生活质量各维度显著高于中转开腹手术组(t=2.311,t=2.265,t=2.253,t=2.297,P0.05)。结论对于符合腹腔镜手术适应证的腹部闭合性损伤患者,积极开展腹腔镜手术,具有手术时间短,出血量少、住院相关费低的优势,应严格控制中转开腹率,提高其应用率。     

纤维蛋白胶和生长激素促进腹腔感染条件下大鼠肠吻合口愈合的研究

目的应用纤维蛋白胶 (fibringlue ,FG)、生长激素 (growthhormone ,GH)于腹腔感染条件下的大鼠小肠吻合 ,探讨其有效性和作用机制。方法将大鼠分为正常对照组和在腹腔感染模型下行标准肠吻合组 (丝线吻合 12针 )、简易吻合组 (丝线吻合 4针 )、简易吻合 +FG组、简易吻合 +GH组、及简易吻合 +FG +GH组共 6组 ,于小肠局部切除吻合术后第 1、3、5天分别观察、测定其吻合口不良愈合率、吻合口爆破压、吻合口羟脯氨酸浓度等指标。结果在感染条件下标准吻合组吻合口爆破压于术后第 1天至第 3天分别为 (18± 10 )mmHg和 (36± 11)mmHg ,不良愈合率达 30 % ;而使用FG行胶合组吻合口强度显著提高 ,分别为 (32± 7)mmHg和 (6 5± 9)mmHg ,不良愈合显著减少 ,仅为11 76 %。在胶合的基础上加用GH与未加用GH组比较 ,羟脯氨酸浓度无显著性差异。结论大鼠在腹腔感染条件下可以使用FG实施小肠肠吻合并减少并发症的发生 ,加用GH后早期疗效提高不显著     

腹腔镜胆囊切除术后腹膜炎的原因及处理对策

目的 探讨腹腔镜胆囊切除术(Laparoscopic Cholecystectomy,LC)后急性腹膜炎发生的原因及处理措施。方法对11000例LC术后急性腹膜炎病例进行回顾分析。结果 本组病例LC术后共16例(0.15％)发生了腹膜炎。其中胆道损伤引起的腹膜炎9例(56.2％),胆囊动脉或分支出血引起的腹膜炎5例(31.4％),十二指肠损伤引起的腹膜炎2例(12.5％),均经外科手术治愈,除1例胆肠吻合术后出现吻合口狭窄经再手术治愈外,无其它并发症。结论 胆漏是LC术后腹膜炎的主要原因;其次为胆囊动脉或其分支出血,消化道损伤虽所占比例较少,但其临床症状重,感染性休克出现早,更应引起临床医师的重视。     

Optimal pressure of abdominal gas insufflation for bleeding control in a severe swine splenic injury model

Background

We previously demonstrated that abdominal gas insufflation (AGI) reduces intra-abdominal bleeding. To date, this is the only method that holds promise for reducing mortality from internal bleeding in a pre-hospital setting. We aimed to assess the optimal AGI pressure and the effectiveness of a portable miniaturized insufflator in abdominal bleeding control.

Materials and methods

We randomized 15 Yorkshire swine to receive AGI of 20, 25 or 30 mm Hg after sustaining a standardized severe splenic injury, to determine the ideal pressure for optimal bleeding control. We randomized six (40%) to insufflation with a custom-designed, battery-operated, 7-oz portable CO₂ tank, whereas we used a standard laparoscopic insufflator for the remainder. Intravenous fluid boluses were administered as needed to maintain a mean arterial pressure of >60 mm Hg. At 30 min, the animals were re-laparotomized and their hemoperitoneum was quantified.

Results

Target peritoneal pressures were achieved and maintained successfully with both insufflation methods. There was a trend toward greater blood loss and fluid requirements in the 30-mmHg group (P = 0.71 and 0.97, respectively). Increasing the AGI led to less predictable blood loss and fluid resuscitation requirements, as well as worsening of tissue perfusion markers (pH and lactate), likely because of iatrogenic abdominal compartment syndrome.

Conclusions

All target peritoneal pressures were easily and reliably achieved with the portable CO₂ insufflator. Abdominal gas insufflation produced optimal bleeding control at 20 mm Hg. This technology could be used in a pre-hospital setting to control otherwise lethal hemorrhage at pressures typically used for standard laparoscopic surgery and proven to be safe.