共查询到20条相似文献,搜索用时 15 毫秒
1.
Effect of insufflation gas and intraabdominal pressure on portal venous flow during pneumoperitoneum in the rat 总被引:15,自引:3,他引:12
BACKGROUND: Carbon dioxide, the primary gas used to establish a pneumoperitoneum, causes numerous systemic effects related to cardiovascular function and acid-base balance. Therefore, the use of other gases, such as helium, has been proposed. Furthermore, the pneumoperitoneum itself, with the concomitant elevation of intraabdominal pressure, causes local and systemic effects that have been only partly elucidated. Portal blood flow, which plays an important role in hepatic function and cell-conveyed immune response, is one of the affected parameters. METHODS: An established animal model (rat) of laparoscopic surgery was extended by implanting a periportal flow probe. Hemodynamics in the portal vein were then measured by transit-time ultrasonic flowmetry during increasing intraabdominal pressure (2-12 mmHg) caused by gas insufflation (carbon dioxide vs helium). RESULTS: The installation of the pneumoperitoneum with increasing intraperitoneal pressure led to a significant linear decrease in portal venous flow for both carbon dioxide and helium. At higher pressure levels (8-12 mmHg), portal blood flow was significantly lower (1.5-2.5-fold) during carbon dioxide pneumoperitoneum. An intraabdominal pressure of 8 mmHg caused a decrease to 38.2% of the initial flow (helium, 59.7%); whereas at 12 mmHg, portal flow was decreased to 16% (helium, 40.5%). CONCLUSION: Elevated intraabdominal pressure generated by the pneumoperitoneum results in a reduction of portal venous flow. This effect is significantly stronger during carbon dioxide insufflation. Portal flow reduction may compromise hepatic function and cell-conveyed immune response during laparoscopic surgery. 相似文献
2.
Insufflation profile and body position influence portal venous blood flow during pneumoperitoneum 总被引:6,自引:0,他引:6
Gutt CN Schmedt CG Schmandra T Heupel O Schemmer P Büchler MW 《Surgical endoscopy》2003,17(12):1951-1957
Background: We investigated changes in portal venous blood flow (PVBF) during carbon dioxide (CO2) pneumoperitoneum to evaluate the effects of different insufflation profiles and body positions. Methods: An established rat model was extended by implanting a portal vein flow probe that would enable us to measure PVBF for 60 min [t0–t60] in animals subjected to a CO2 pneumoperitoneum with an intraabdominal pressure (IAP) of 9 mmHg. Forty-eight male Sprague-Dawley rats were randomized into the following four experimental and two control groups: decompression group D1 (n = 8), desufflation for 1 min every 14 min; decompression group D2 (n = 8), desufflation for 5 min, after 27 min; position group P1 (n = 8), 35° head-up position; position group P2 (n = 8), 35° head-down position; negative control group C1 (n = 8), no insufflation; positive control group C2 (n = 8), constant IAP of 9 mmHg for 60 min. Results: Pneumoperitoneum and body positions, respectively, reduced PVBF [t1–t60] significantly (p < 0.001) by 32.0% C2, 32.8% D1, 31.1% D2, 40.8% P1, and 48.5% P2, as compared to PVBF at t0 in each group. There was a significant difference in PVBF reduction between P1 and P2 and also between C2 and both P1 and P2 (p < 0.04). Conclusions: CO2 pneumoperitoneum reduces PVBF significantly (>30%). Extreme body positions (35° tilt) significantly intensify PVBF reduction. PVBF reduction is significantly more dramatic in subjects placed in a 35° head-down position. Short desufflation periods did not improve mean PVBF, but it may have beneficial immunological and oncological effects that warrant further investigation.
Presented at the annual meeting of the European Association for Endoscopic Surgery (EAES), Lisbon, Portugal, 2002. 相似文献
3.
Laparoscopic insufflation of the abdomen reduces portal venous flow 总被引:31,自引:12,他引:19
Background: The adverse effects of sustained elevated intraperitoneal pressure (IPP) on cardiovascular, pulmonary and renal systems have
been well documented by several reported experimental and clinical studies. Alteration in the splanchnic circulation has also
been reported in animal experiments, but details of the exact hemodynamic changes in the flow to solid intraabdominal organs
brought on by a raised intraperitoneal pressure in the human are not available. The aim of the present study was to estimate
effect of increased IPP on the portal venous flow, using duplex Doppler ultrasonography in patients undergoing laparoscopic
cholecystectomy.
Methods: The studies were performed using the SSD 2000 Multiview Ultrasound Scanner and the UST 5536 7.0-MHz laparoscopic transducer
probe. Details of the measurements were standardized in according to preset protocol. Statistical evaluation of the data was
conducted by the two-way analysis of variance (ANOVA).
Results: The flow measurement data have demonstrated a significant (p < 0.001) decrease in the portal flow with increase in the intraperitoneal pressure. The mean portal flow fell from 990 ±
100 ml/min to 568 ± 81 ml/min (−37%) at an IPP of 7.0 mmHg and to 440 ± 56 mmHg (−53%) when the IPP reached 14 mmHg.
Conclusions: The increased intraperitoneal pressure necessary to perform laparoscopic operations reduces substantially the portal venous
flow. The extent of the volume flow reduction is related to the level of intraperitoneal pressure. This reduction of flow
may depress the hepatic reticular endothelial function (possibly enhancing tumor cell spread). In contrast, the reduced portal
flow may enhance cryo-ablative effect during laparoscopic cryosurgery for metastatic liver disease by diminishing the heat
sink effect. These findings suggest the need for a selective policy, low pressure or gas-less techniques to positive-pressure
interventions, during laparoscopic surgery in accordance with the disease and the therapeutic intent.
Received: 19 March 1996/Accepted: 4 July 1997 相似文献
4.
Pross M Schulz HU Flechsig A Manger T Halangk W Augustin W Lippert H Reinheckel T 《Surgical endoscopy》2000,14(12):1180-1184
Background: Clinical trials have found that the pneumoperitoneum has potentially hazardous side effects. The biochemical basis of organ
injury induced by pneumoperitoneum is, however, not well defined. Since oxidative stress is believed to play an important
role in many pathological conditions, we set out to examine oxidative stress markers in the lung, liver, kidney, and pancreas
by using a rat model of laparoscopy with CO2 pneumoperitoneum and comparing it to a group with gasless laparoscopy.
Methods: Malondialdehyde (for lipid peroxidation), protein-bound carbonyls (for protein oxidation), reduced and oxidized glutathione,
and the neutrophil marker myeloperoxidase were evaluated in tissue homogenates at 2 h, 6 h, and 18 h after laparoscopy. Immunoblotting
was used to analyze the modification of lung proteins by 4-hydroxynonenal at 6 h.
Results: Significant lipid peroxidation was found selectively in lungs at 2 h and 6 h after CO2 pneumoperitoneum. This was accompanied by a loss of glutathione but only minor protein oxidation. Further, lung proteins
were clearly modified by the aldehydic product of lipid peroxidation 4-hydroxynonenal. Myeloperoxidase in lungs increased
continuously up to 18 h in both experimental groups, but there were higher levels in the group with pneumoperitoneum.
Conclusion: Oxidative stress is likely to contribute to the impairment of pulmonary function after laparoscopic operations using a CO2 pneumoperitoneum.
Received: 22 November 1999/Accepted: 22 March 2000/Online publication: 10 July 2000 相似文献
5.
CO2气腹对肝硬变大鼠门脉血流影响的实验研究 总被引:3,自引:3,他引:3
目的 探讨CO2 气腹对肝硬变大鼠门脉血流量的影响。 方法 制作肝硬变大鼠模型 ,施加不同压力的气腹 ,分别测平均动脉压、门静脉压力、下腔静脉压、门静脉血流 ,计算门静脉阻力。 结果 平均动脉压、下腔静脉压在不同气腹压力下无明显变化 ,两组大鼠门静脉压力在 10mmHg时出现显著差异 ,随着压力的升高而升高。正常大鼠的门静脉血流量在 2 0mmHg下与 0mmHg下比较有显著差异 ,而肝硬变大鼠的门静脉血流量在 10mmHg下与 0mmHg下比较已有显著差异。正常大鼠门静脉阻力随着压力的升高在 10mmHg时出现显著差异 ,以后继续升高 ,肝硬化大鼠门静脉阻力随着压力的升高持续升高。 结论 CO2 气腹致肝硬化大鼠门静脉血流减少 ,且减少程度重于正常大鼠 相似文献
6.
The effects of pneumoperitoneum on gastric blood flow and traditional hemodynamic measurements 总被引:3,自引:3,他引:0
Background: The purpose of this study was to investigate the effects of increasing intraabdominal pressure (IP) on gastric blood flow,
as measured by gastric tonometry and traditional hemodynamic measurements.
Methods: Nine swine were anesthetized, intubated, and ventilated. Arterial and pulmonary artery catheters were placed by cutdown,
a trocar was placed in the abdomen, and a gastric tonometer was placed in the stomach. Serial measurements of arterial and
mixed venous blood gases, cardiac output, wedge pressure, lactic acid, and gastric intramucosal pH (pHi) were collected at intraperitoneal pressures of 0, 8, 10, 12, 14, 16, and 18 mm Hg after 30 min equilibration. Statistical
analysis included Pearson correlation and Student's t test.
Results: Increasing levels of IP were correlated with decreased arterial pH (p < 0.00003), increased mixed venous CO2 (p < 0.003), decreased intramucosal pH (p < 0.014), and increased arterial CO2 (p < 0.015). Gastric pHi differed significantly from baseline at IP levels of 16 mm Hg (p < 0.004) and 18 mm Hg (p < 0.01). No significant effects were observed on cardiac output or arterial lactate. No significant effects were observed
in a control group that had been insufflated to 8 mm Hg and held constant over 3 h.
Conclusions: In this model, gastric blood flow is adversely affected by increasing IP with pronounced effects in excess of 15 mm Hg. These
results suggest that gastric tonometry may be used to monitor the adverse effects of pneumoperitoneum. Gastric pHi may be an earlier indicator of altered hemodynamic function during laparoscopy than traditional measures.
Received: 25 March 1997/Accepted: 30 June 1997 相似文献
7.
Background: Laparoscopic procedures of increasing difficulty and duration are becoming more and more common. This may cause significant
challenges to the circulatory system and possibly influence thrombogenicity.
Methods: Experimental study of carbon dioxide pneumoperitoneum in pigs.
Results: Inferior caval vein blood flow remained unchanged, whereas inferior caval vein pressure increased during pneumoperitoneum.
Inferior caval vein, pulmonary, and systemic vascular resistance increased during pneumoperitoneum and remained increased
after exsufflation.
Conclusions: Pneumoperitoneum leads to an increased inferior caval vein pressure, which could cause a dilation of peripheral veins. The
similar patterns of vascular resistance in the inferior caval vein, pulmonary artery, and systemic arteries (a gradual increase
remaining elevated after exsufflation) suggest a common humoral factor or increased sympathetic nerve activity.
Received: 2 April 1996/Accepted: 7 June 1996 相似文献
8.
Characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum 总被引:19,自引:4,他引:15
Objective: Any route of entry into the abdomen contributes to alterations of the intraperitoneal organs with different clinical consequences.
Characteristic alterations of the peritoneum after CO2 pneumoperitoneum used in laparoscopic surgery is examined.
Methods: A CO2 pneumoperitoneum with an intraperitoneal pressure of 6 mmHg was applied for 30 min in 32 nude mice. In the course of 4 days,
the animals were killed and the peritoneal surface of the abdominal wall was studied by means of scanning electron microscopy.
Results: Already 2 h after release of the pneumoperitoneum, mesothelial cells were bulging up. The intercellular clefts thereby increased
in size, and the underlying basal lamina became visible. This reaction peaked after 12 h. Subsequently, peritoneal macrophages
and lymphocytes filled all gaps, thereby recovering the basal lamina.
Conclusion: The morphologic integrity of the peritoneum is temporarily disturbed by a CO2 pneumoperitoneum.
Received: 9 March 1998/Accepted: 24 July 1998 相似文献
9.
Intraperitoneal immunity and pneumoperitoneum 总被引:15,自引:5,他引:10
E. G. Chekan C. Nataraj E. M. Clary T. Z. Hayward F. J. Brody J. C. Stamat M. C. Fina W. S. Eubanks C. J. Westcott 《Surgical endoscopy》1999,13(11):1135-1138
Background: Carbon dioxide (CO2) pneumoperitoneum has been implicated as a possible factor in depressed intraperitoneal immunity. Using in vitro functional
assays, CO2 has been shown to decrease the function of peritoneal macrophages harvested from insufflated mice. However, an effective
in vivo assessment is lacking. Listeria monocytogenes (LM), an intracellular pathogen, has served as a well-established in vivo model to study cell-mediated immune responses in mice.
This study examines the immune competence of mice based on their ability to clear intraperitoneally administered LM following CO2 vs helium (He) insufflation.
Methods: Eighty-five mice (C57Bl/6, males, 4–6 weeks old) were divided between the following four treatment groups: CO2 insufflation, He insufflation, abdominal laparotomy (Lap), and control (anesthesia only). Immediately postoperatively, each
group was inoculated percutaneously and intraperitoneally with a sublethal dose (.015 × 106 org) of virulent LM (EGD strain). Half of the animals were killed on postoperative day 3 and half on day 5. Spleens and livers (sites of bacterial
predilection) were harvested, homogenized, and plated on TSB agar. The amount of bacteria (1 × 106
LM/spleen and liver) from each group was then compared. Statistical significance was set at p≤ 0.05.
Results: Control animals had nominal bacteria on day 3 (0.016 × 106
LM/spleen and liver), and the bacterial burden remained low at day 5 (0.038 × 106
LM/spleen and liver) postchallenge. On day 3, the bacterial burden was significantly higher in the CO2 group (5.46 × 106
LM/spleen and liver) as compared to He (0.093 × 106
LM/spleen and liver) and controls. The Lap group (3.44 × 106
LM/spleen and liver) had significantly more bacteria than the controls. There were no significant differences between any of
the groups on day 5.
Conclusions: In this animal model, CO2 pneumoperitoneum impaired cell-mediated intraperitoneal immunity significantly more than He pneumoperitoneum and controls
on day 3. Also on day 3, laparotomy caused impairment of intraperitoneal immunity when compared to controls. Finally, intraperitoneal
immunosuppression resolved by day 5.
Received: 22 July 1998/Accepted: 3 March 1999 相似文献
10.
Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy 总被引:10,自引:4,他引:6
S. Takagi 《Surgical endoscopy》1998,12(5):427-431
Background: Laparoscopy under carbon dioxide (CO2) pneumoperitoneum has many advantages. However, the risks of CO2 pneumoperitoneum during laparoscopic hepatectomy (LH) have not been defined.
Methods: The hemodynamics of the hepatic vein were examined during CO2 pneumoperitoneum both pre- and posthepatectomy in eight pigs. Portal blood flow was measured with Doppler ultrasound during
laparoscopic cholecystectomy in 10 human patients.
Results: Experimentally, elevated intraabdominal pressure (IAP) with CO2 insufflation produced significant increases in CO2 partial pressure and echogenicity of the hepatic vein in the posthepatectomy group. Clinically, elevated IAP caused significant
narrowing of the portal vein and significant decreases in portal blood velocity. The mean portal flow was significantly decreased
with elevation of IAP >10 mmHg.
Conclusions: LH with CO2 pneumoperitoneum may lead to embolism caused by CO2 bubbling through the hepatic vein. Elevated IAP may cause a decrease in hepatic blood flow and induce severe liver damage,
especially in patients with poor liver function. Gasless laparoscopy using abdominal wall lifting should be employed in LH
to avoid the risks of CO2 embolism and liver damage.
Received: 28 March 1997/Accepted: 12 September 1997 相似文献
11.
The adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy 总被引:11,自引:0,他引:11
Background: The increased intra-abdominal pressure during pneumoperitoneum, together with the head-up tilt used in upper abdominal laparoscopies,
would be expected to decrease venous return to the heart. The goal of our study was to determine whether laparoscopy impairs
cardiac performance when preventive measures to improve venous return are taken, and to analyze the effects of positioning,
anesthesia, and increased intra-abdominal pressure.
Methods: Using invasive monitoring, hemodynamic changes were investigated in 15 ASA class I or II patients under isoflurane–fentanyl
anesthesia during laparoscopic cholecystectomy. Before laparoscopy, the patients received an intravenous (IV) infusion of
colloid solution if cardiac filling pressures were low, and their legs were wrapped from toes to groin with elastic bandages.
Measurements were taken while the patients were awake in the supine (baseline) and head-up tilt (15–20°) positions, and after
the induction of anesthesia in the same positions. Measurements were repeated at regular intervals during laparoscopy (intra-abdominal
pressure at 13–16 mmHg), after deflation of the gas, and in the recovery room.
Results: With the passive head-up tilt in awake and anesthetized patients, the cardiac index (CI), stroke index (SI), central venous
pressure (CVP), and pulmonary capillary wedge pressure (PCWP) decreased, and systemic vascular resistance increased. With
the patient under anesthesia, SI decreased, but CI did not change significantly as a result of the compensatory increase in
heart rate. Carbon dioxide (CO2) insufflation at the start of laparoscopy produced increases in CVP and PCWP as well as mean systemic and mean pulmonary
arterial pressures without changes in CI or SI. Toward the end of the laparoscopy, CI decreased by 15%. The hemodynamic values
returned to nearly prelaparoscopic levels after deflation of the gas, and CI was elevated during the recovery period, whereas
systemic vascular resistance was decreased in comparison with the baseline.
Conclusions: By correcting relative dehydration and preventing the pooling of blood, CI decreased less than 20% during pneumoperitoneum
as compared with the baseline awake level. The head-up positioning accounts for many of the adverse effects in hemodynamics
during laparoscopic cholecystectomy.
Received: 6 November 1998/Accepted: 8 July 1999 相似文献
12.
A. Valeri F. Venneri L. Presenti F. Nardi A. Grossi D. Borrelli 《Surgical endoscopy》1998,12(9):1173-1176
Portal thrombosis is a rare complication of splenectomy. We performed 12 laparoscopic splenectomies and observed this complication
only in one patient with idiopathic thrombocytopenia (ITP). The right branch of the portal vein presented a partial thrombosis,
while the left branch was completely obstructed by thrombi. Abdominal ultrasonography and an ultrasound doppler exam allowed
us to diagnose this event and a retrograde angiography performed afterward confirmed our diagnosis. A 48-h intravenous heparin
treatment was promptly begun, followed by anticoagulant drugs (dicumarol). The patient was dismissed 5 days afterward, presenting
a steady-state ultrasound doppler pattern and a complete normalization of liver parameters. An ultrasound doppler exam performed
1 month after anticoagulant therapy showed a complete resolution of portal thrombosis. We believe that early diagnosis of
this rare complication, prompt beginning of anticoagulant therapy, and care in surgical procedures may reduce patient life-threatening
risks and assure complete remission.
Received: 18 March 1997/Accepted: 18 September 1997 相似文献
13.
Effect of carbon dioxide pneumoperitoneum on bacteremia and severity of peritonitis in an experimental model 总被引:3,自引:3,他引:0
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 相似文献
14.
X. Sala-Blanch J. Fontanals G. Martínez-Palli P. Taurá S. Delgado J. Bosch A. M. Lacy J. Visa 《Surgical endoscopy》1998,12(9):1121-1125
Background: Elevated intraabdominal pressure due to gas insufflation for laparoscopic surgery may result in regional blood flow changes.
Impairments of hepatic, splanchnic, and renal blood flow during peritoneal insufflation have been reported. Therefore we set
out to investigate the effects of peritoneal insufflation with helium (He) and carbon dioxide (CO2) on hepatic blood flow in a porcine model.
Methods: Twelve pigs were anesthetized and mechanically ventilated with a fixed tidal volume after the stabilization period. Peritoneal
cavity was insufflated with CO2 (n= 6) or He (n= 6) to a maximum intraabdominal pressure of 15 mmHg. Hemodynamic parameters, gas exchange, and oxygen content were studied
at baseline, 90 mm and 150 min after pneumoperitoneum, and 30 min after desufflation. Determination of hepatic blood flow
with indocyanine green was made at all measured points by a one-compartment method using hepatic vein catheterization.
Results: A similar decrease in cardiac output was observed during insufflation with both gases. Hepatic vein oxygen content decreased
with respect to the baseline during He pneumoperitoneum (p < 0.05), but it did not change during CO2 insufflation. Hepatic blood flow was significantly reduced in both the He and CO2 pneumoperitoneums at 90 min following insufflation (63% and 24% decrease with respect to the baseline; p < 0.001 and p < 0.05, respectively) being this decrease marker in the He group (p= 0.02).
Conclusions: These findings suggest that helium intraperitoneal insufflation results in a greater impairment on hepatic blood flow than
CO2 insufflation.
Received: 27 March 1996/Accepted: 19 January 1997 相似文献
15.
Duration of postlaparoscopic pneumoperitoneum 总被引:4,自引:0,他引:4
Background: Patients who present with abdominal pain after recent laparoscopic surgery present a diagnostic dilemma when pneumoperitoneum
is present. Previous studies do not define the duration of postlaparoscopic pneumoperitoneum. In this study, we attempted
to define the duration of laparoscopic pneumoperitoneum and to identify factors which affect resolution time.
Methods: We followed 57 patients who underwent laparoscopic cholecystectomy (34), inguinal herniorraphy (20), or appendectomy (three).
Serial abdominal films were taken until all residual gas was resolved.
Results: Thirty patients resolved their pneumoperitoneum within 24 h; 16 patients resolved between 24 h and 3 days; nine patients
resolved between 3 and 7 days; two patients resolved between 7 and 9 days. Mean resolution time for all patients was 2.6 ±
2.1 days. There was no apparent difference in resolution time between the three types of procedures; however, the sample size
may be insufficient. Duration of the pneumoperitoneum did not correlate with gender, age, weight, initial volume of CO2 used, length of time for the procedure, or postoperative complications. Sixteen patients had bile spillage during cholecystectomy
which significantly reduced the duration of postoperative pneumoperitoneum (p < 0.008), resulting in a mean resolution time of 1.3 ± 0.9 days. While 14 patients reported postoperative shoulder pain,
no correlation was found between the presence or duration of shoulder pain and the extent or duration of pneumoperitoneum.
Conclusions: We conclude that the residual pneumoperitoneum following laparoscopic surgery resolves within 3 days in 81% of patients and
within 7 days in 96% of patients. The resolution time was significantly less in patients sustaining intraoperative bile spillage
during cholecystectomy. There was no correlation found between postoperative shoulder pain and the presence or duration of
the pneumoperitoneum.
Received: 22 March 1996/Accepted: 12 July 1996 相似文献
16.
M. R. Evasovich T. C. Clark M. C. Horattas S. Holda L. Treen 《Surgical endoscopy》1996,10(12):1176-1179
Background: To evaluate the impact of laparoscopy in the presence of peritonitis, this study was designed to assess bacteremia caused
by E. coli–induced peritonitis with a carbon dioxide pneumoperitoneum in a rat model.
Methods: Sixty Sprague-Dawley rats were divided into inoculum groups (no E. coli, 106 colony-forming units [CFU] E. coli, and 108 CFU E. coli), followed by induction of a carbon dioxide pneumoperitoneum or no pneumoperitoneum. Fifteen-minute-interval blood cultures
were obtained to determine time of bacteremia development. Statistical assessment to determine significant differences among
groups was done using ANOVA and t-test analysis.
Results: A total of 20 animals with E. coli introduced into the peritoneum and a carbon-dioxide-induced pneumoperitoneum had more frequent positive blood cultures at
all time intervals compared to identical inoculum subgroups without a pneumoperitoneum. ANOVA revealed a significant difference
in bacteremia within the same concentration inoculum groups in animals receiving a pneumoperitoneum vs none (p < 0.01). Bacteremia increased significantly as inoculum concentrations increased (25% with 106
E. coli inoculum vs 80% with 108
E. coli), especially among the insufflated subgroups (45% with 106
E. coli vs 100% with 108
E. coli) over 180 min (p < 0.01).
Conclusion: Carbon dioxide pneumoperitoneum increases the incidence of E. coli bacterial translocation from the peritoneum into the bloodstream in this rat model.
Received: 30 April 1996/Accepted: 5 July 1996 相似文献
17.
Takiguchi S Matsuura N Hamada Y Taniguchi E Sekimoto M Tsujinaka M Shiozaki H Monden M Ohashi S 《Surgical endoscopy》2000,14(1):41-44
Background: CO2 pneumoperitoneum provides a new surgical environment to treat malignant disease. The purpose of this study was to investigate
the influence of CO2 pneumoperitoneum during laparoscopic surgery on cancer cell growth.
Methods: WiDr human colon cancer cells were incubated for 3 h under the following two conditions: 100% CO2 at 10 mmHg, and 95% air/5% CO2 (control). Cell proliferation was assessed by the WST-1 assay and BrdU assay. Tumor growth was assessed by subcutaneous injection
into 20 nude mice. Cellular damage was measured by lactate dehydrogenase (LDH) assay.
Results: The number of WiDr cells under pneumoperitoneal conditions decreased in the first 24 h. However, no significant difference
was observed in the proliferation rate and tumor growth of the viable cells. LDH release of the CO2 pneumoperitoneal group was higher than that of the controls.
Conclusions: Our data indicate that CO2 pneumoperitoneum does not promote cancer cell proliferation but instead has a toxic effect on cancer cells.
Received: 19 March 1999/Accepted: 15 June 1999 相似文献
18.
Alterations in hemodynamics and left ventricular contractility during carbon dioxide pneumoperitoneum 总被引:9,自引:2,他引:7
U. S. Marathe R. E. Lilly S. C. Silvestry P. R. Schauer J. W. Davis T. N. Pappas D. D. Glower 《Surgical endoscopy》1996,10(10):974-978
Background: Carbon dioxide (CO2) pneumoperitoneum has been shown to adversely affect hemodynamics in patients. This study specifically examines the potential
contribution of altered left ventricular contractility (LVC) to hemodynamic changes observed during CO2 pneumoperitoneum.
Methods: In a canine model, LV volumes, LV pressure, and intrathoracic and central venous pressures were recorded both at basal intra-abdominal
pressure (IAP) and after CO2 insufflation to produce IAPs of 5–25 mmHg.
Results: At IAPs greater than 15 mmHg, cardiac output and LV end-diastolic volume decreased. Mean arterial pressure and heart rate
were unchanged. LVC, quantified using the linear Frank-Starling relationship, was not affected by increases in IAP.
Conclusions: This study is the first to quantify LVC during CO2 pneumoperitoneum and demonstrates no changes in contractility over IAPs from 5 to 25 mmHg. In the dog model, any hemodynamic
alterations induced by CO2 pneumoperitoneum are secondary to altered LV preload and not alterations in contractility or LV afterload.
Received: 8 March 1996/Accepted: 23 April 1996 相似文献
19.
Experimental studies demonstrated a severe cardiac load of the CO2 pneumoperitoneum caused by an accelerated after- and a decreased preload. Patients displaying cardiovascular risks are therefore
often rejected from laparoscopic surgery. Hence, the pathophysiological changes and the intraoperative risk of the CO2 pneumoperitoneum in high-risk cardiopulmonary patients (NYHA II–III, n= 15) undergoing laparoscopic cholecystectomy are described. The changes in cardiac after- and preload seem to be due to the
elevated intraabdominal pressure rather than transperitoneally resorbed CO2 and are reversible by desufflation. In one patient conversion to open operation had to be performed because of a severe drop
in cardiac output and right ventricle ejection fraction. Mixed oxygen saturation was predicting intraoperative worsening in
this case. The described pathophysiological changes may seem to be well tolerated even in high-risk cardiac patients. Monitoring
of hemodynamics should include an arterial catheter line and blood gas analyses. Pharmacologic interventions or pressureless
laparoscopic procedures might not be necessary as long as laparoscopic cholecystectomy is performed.
Received: 13 December 1996/Accepted: 8 January 1997 相似文献
20.
Pneumoperitoneum risk prognosis and correction of venous circulation disturbances in laparoscopic surgery 总被引:1,自引:0,他引:1
S. I. Emeljanov V. V. Fedenko E. M. Levite S. A. Panfilov I. G. Bobrinskaya A. V. Fedorov N. L. Matveev V. V. Evdoshenko S. V. Luosev V. V. Bokarev S. R. Musaeva 《Surgical endoscopy》1998,12(10):1224-1231
Background: This study was initiated to find a method of determining the prognosis for possible changes in hemodynamic and respiratory
parameters in patients with pneumoperitoneum (PP).
Methods: We devised a model for a pseudopneumoperitoneum (PPP), which is created by encircling the wide pneumochamber on the entire
abdomen and inflating it to a preset pressure. To verify the prognostic possibilities of the proposed model, we studied the
pneumotachygraphy parameters, noninvasive and invasive monitoring parameters of PPP after induction of anaesthesia, and venous
circulation disturbances, as well as the medical effect of the intermittent sequential compression device.
Results: In healthy patients, the restrictive lung syndrome did not approach the risky limit. In patients ≥60 years old, this syndrome
was very close to the limit. In a number of patients with serious cardiovascular and pulmonary pathology, the pressure of
>10 mmHg was considered to be intolerable. Lung compliance, which was the parameter most sensitive to the increased intraabdominal
pressure, was 47 ± 10 at baseline, and 29 ± 4 (p > 0.05) at both PPP and real PP (14 mmHg).
Conclusions: The PPP model is quite similar to the real PP and can be used for preoperative prognosis in laparoscopic surgery. The elevated
intraabdominal pressure results in a significant disturbance of venous blood flow in the lower extremities. The use of the
device for peristaltic pneumomassage of the lower limbs is effective in correcting negative changes in venous hemodynamics
in laparoscopic surgery.
Received: 28 July 1997/Accepted: 12 January 1998 相似文献