The effect of timing of pneumoperitoneum on the inflammatory response

Background We examined the effects of an identical period of pneumoperitoneum applied at three different time points after lipopolysaccharide (LPS) challenge. Two different insufflation gases were also compared. Methods Male rats (n = 70) were injected intravenously with 1 mg/kg of LPS (time 0). The time relationship between a 1.5-h period of insufflation and initial LPS stimulation was the experimental variable. All rats were killed 6 h after injection. CO₂ and helium insufflation were investigated. Ten control rats received LPS only. Serum interleukin-6 (IL-6) levels were determined by enzyme-linked immunosorbent assay (ELISA). Hepatic expression of α₂-macroglobulin, β-fibrinogen, and metallothionein were measured by Northern blot analysis. Statistical analysis was performed using one-way analysis of variance (ANOVA). Results Expression of α₂-macroglobulin mRNA was lower in CO₂ groups compared to the control group (p < 0.05 at time 120 and 270). β-Fibrinogen message was diminished in CO₂ 0 and 120 groups compared to control. Serum levels of IL-6 and expression of metallothionein mRNA did not show significant differences between groups. Conclusions These findings suggest that CO₂ pneumoperitoneum downregulates the inflammatory response to LPS challenge. Start time of CO₂ insufflation does not appear to alter hepatic expression of acute phase genes. The mechanism of α₂-macroglobulin downregulation does not appear to be due to IL-6.     

炎症反应在心肌缺血/再灌注损伤中作用的研究进展

背景 心肌缺血/再灌注损伤(ischemia/reperfusion injury,I/RI)是指在缺血心肌恢复血流灌注后,细胞代谢功能障碍和结构破坏反而加重的现象,并且伴随有以炎症细胞浸润和细胞因子产生为特征的炎症反应.目前认为,炎症反应是I/RI的重要病理机制之一,再灌注诱发的炎症反应及其介质可加重心肌I/RI,而...     

腹腔镜和开腹结直肠手术的炎性反应比较

目的对比分析腹腔镜和开腹结直肠手术患者全身和腹腔炎性反应的差异,为腹腔镜手术对结直肠肿瘤中的应用提供理论依据。方法对51例2004年4-8月间收治的乙状结肠和直肠恶性肿瘤患者,采用腹腔镜辅助手术25例(LAP组),开腹手术26例(OPEN组)。术毕骶前留置引流管。观察并比较两组患者的一般情况和炎性反应及与手术相关的各项指标。结果两组患者在年龄、性别、ASA分级、术前血红蛋白及白蛋白水平、肿瘤Dukes分期和手术方式差异均无统计学意义(P＞0．05)。在切口长度、手术时间、肠道功能恢复时间、住院时间的比较中,LAP组占有明显优势(P＜0．05)。腹腔引流量在术后第1天,两组间差异无统计学意义(P＞0．05)；而术后2-4 d,LAP组明显低于OPEN组(P＜0．05)。LAP组术后第1天,周围血中性粒细胞[(7．30±2．62)×10~9/L]、白介素(IL)-10[(19．46±3．31)pg/ml]和C反应蛋白(CRP)[(2．76±2．17)mg/dl]水平均显著低于OPEN组(P＜0．05)。术后第4天两组间差异无统计学意义(P＞0．05)。术后第1天,两组腹腔引流液的IL-10、肿瘤坏死因子(TNF)及CRP水平差异无统计学意义(P＞0．05),术后第4天LAP组IL-10 [(22．53±15．47)pg/ml]明显低于OPEN组(P＜0．05)。结论术后早期,腹腔镜结直肠手术的腹腔炎性反应与开腹手术相当,而全身炎性反应较开腹手术轻。腹腔镜结直肠手术临床上体现出恢复快、并发症少、住院天数少的优势。     

Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen

Aim

Idiopatic thrombocytopenic purpura (ITP) is the most common indication for splenectomy. The failure rate of surgery is about 8% and the failure rate after splenectomy is approximately 28% for all patients. When the presence of an accessory spleen is diagnosed, splenectomy is recommended. Laparoscopic approach is considered the first choice.

Patients and methods

At our Department, between July and November 2011 two patients underwent laparoscopic accessory splenectomy for recurrence of ITP. Both patients had a previously laparoscopic splenectomy. Preoperative Magnetic Resonance (MR) was performed in both the cases revealing the presence of an accessory spleen.

Results

The operative time was 105 and 100 minutes respectively. No perioperative complications occured. Hospital stay was four days in both cases. The first patient had a disease free period of two months; the second one of one month. Both patients restarted immunosuppressive therapy.

Conclusions

The relapse of thrombocytopenia post-splenectomy can be associated with the presence of an accessory spleen. The laparoscopic accessory splenectomy should be considered the first choice approach. Surgical accessory splenectomy allows a transitory remission of the disease.     

腹腔镜与开腹结直肠癌根治术后全身炎症反应综合征比较

目的 观察腹腔镜和开腹结直肠癌根治术患者术后全身炎症反应综合征(SIRS)的发生,比较两种不同手术方式对患者的创伤程度.方法 将85例结直肠癌患者分成开腹手术组(OP组,n=33)和腹腔镜手术组(LP组,n=52),检测术后患者SIRS发生率和持续时间,采用酶联免疫吸附法(ELISA)连续检测血清肿瘤坏死因子(TNF)-а、白细胞介素(IL)-6及IL-10水平.结果 与OP组比较,LP组患者血清TNF-а和IL-6水平明显降低,IL-10水平升高,差异有统计学意义(P<0.01).LP组SIRS发生率为36.5%,低于OP组的63.6%(P<0.01),SIRS持续时间短于OP组(P<0.05).结论 腹腔镜结直肠癌根治术术后患者SIRS发生率和程度较低,对机体创伤较小.     

二级脾蒂结扎速两步离断法在腹腔镜脾切除术中的应用

目的 探讨腹腔镜脾切除术采用结扎速血管闭合系统(LigaSure)二级脾蒂两步离断法处理脾蒂及联合应用超声刀离断脾周韧带的安全性、有效性及经济性.方法 总结分析32例腹腔镜脾切除术应用LigaSure二级脾蒂两步离断法及联合超声刀离断脾周韧带的体会及治疗效果.其中男性4例,女性28例;年龄16～64岁,中位年龄36岁.脾脏长径11～23 cm,平均长径17 cm;特发性血小板减少性紫癜19例、遗传性球形红细胞增多症6例(其中同一家系5例)、溶血性贫血3例、脾外伤血肿感染2例、Evan综合征1例、白血病1例.术中采用LigaSure及超声刀相结合离断脾周韧带,当脾蒂处于充分游离的状态时,采取二级脾蒂LigaSure两步离断法切断脾蒂.第一步在胰尾侧用LigaSure先闭合脾蒂但不切断,第二步于脾侧用LigaSure闭合脾蒂并切断.结果 32例手术均获成功,其中4例家族性遗传性球形红细胞增多症患者同时联合腹腔镜胆囊切除术,无中转手术,平均手术时间70 min(55～130 min),术中平均出血200 ml(50～600 ml),无腹腔出血、无内脏损伤、无胰漏及腹腔感染等并发症,全部治愈出院,平均术后住院6 d.手术免除应用Endo-GIA,平均每例节省手术费用8050元(920～6900元).结论 腹腔镜脾切除术中应用LigaSure二级脾蒂两步离断法处理脾蒂及联合超声刀离断脾周韧带安全可靠,手术时间明显缩短,出血少,且可降低医疗费用,实现了低成本微创外科.     

Symptomatic pelvic accessory spleen

Accessory spleens are found most commonly at the splenic hilum, however, they rarely are symptomatic. An 18-year-old man presented with lower abdominal pain. Cross-sectional imaging studies with 3-dimensional reconstruction suggested the presence of a mass that was associated with the spleen. A nuclear medicine radioisotope scan confirmed that the mass was a pelvic accessory spleen. Laparoscopic excision was performed with excellent results. This accessory spleen was unusual in its size and location. Accessory spleens should be removed if symptomatic or if they are identified at splenectomy for hematologic disease.     

抑肽酶剂量对体外循环炎性反应的作用及影响

目的：观察不同剂量抑肽酶对体外循环（ＣＰＢ）心脏手术炎性反应的作用及差异。方法：３２例拉膜置换病人,随机双盲分为３组：对照组、抑肽酶小剂量组、抑肽酶大剂量组,分别于ＣＰＢ前、ＣＰＢ结束、停机后２h取桡动脉血,测定中性粒细胞ＣＤ１１b表达及细胞因子ＴＮＦ－α、ＩＬ－６血浆清凉,:凶肽酶大剂量组中性粒细胞ＣＤ１１b的表达,细胞因子ＴＮＦ－α血浆水平各时间点无明变化,且ＩＬ－６释放减少,小剂量抑肽酶只在停机后２h部分下调ＣＤ１１b表达及降低ＴＮＦ－α血浆水平,两组相比,小剂量抑肽酶作用明显减弱,结论：抑肽酶的抗赕作用存在量效关系,大剂量抑肽酶的效能好于小剂量抑肽酶。     

脾切除对大鼠血浆及肝肺组织中内毒素廓清的影响

目的 观察脾切除对血浆中内毒素清除的影响及内毒素在主要脏器的分布特征,探索脾切除后上反应与组织损害的发生机制。方法 雄性Ｗｉｓｔａｒ大鼠１１２只,随机分为有脾组（ｎ＝５６,行大网膜切除术,保留脾脏）、脾切除组（ｎ＝５６,行脾切除术）。术后１周静脉注射内毒素０．１ｍｇ／ｋｇ,分别于注射前、注射后１０ｍｉｎ、０．５、１．５、４、１２、２４ｈ活杀动物,测定血浆和肝、肺组织内毒素水平,同时检测肝、肺脏器功     

右美托咪定通过c-Fos/NLRP 3/caspase-1级联抑制LP S诱发的小胶质细胞炎症反应

目的探讨右美托咪定通过c-Fos/NLRP3/caspase-1级联抑制脂多糖(LPS)诱发的小胶质细胞炎症反应。方法选取新生的SD大鼠,取其小胶质细胞进行原代培养及分离纯化。采用LPS诱导建立小胶质细胞炎症模型。采用MTT法选取右美托咪定抑制LPS诱导小胶质细胞炎症反应的最适宜浓度。将细胞分为三组:对照组、LPS组和右美托咪定治疗组(D组)。采用实时定量PCR法测定细胞中IL-1β和TNF-α的mRNA表达量;采用ELISA法检测细胞上清液中IL-1β和TNF-α的含量;采用Western blot法检测原癌基因c-Fos、NLRP3和caspase-1的蛋白含量。结果与对照组比较,LPS组小胶质细胞中炎性因子IL-1β和TNF-α的mRNA表达量均明显升高(P0.05);D组IL-1β和TNF-α的mRNA表达量明显低于LPS组(P0.05)。与对照组比较,LPS组中小胶质细胞中炎性因子IL-1β和TNF-α的含量均明显增加(P0.05);而D组IL-1β和TNF-α的含量明显低于LPS组(P0.05)。与对照组比较,LPS组小胶质细胞中c-Fos、NLRP3和caspase-1的蛋白含量均明显增加(P0.01);而D组c-Fos、NLRP3和caspase-1的蛋白含量明显低于LPS组(P0.05)。结论右美托咪定可抑制LPS诱发的小胶质细胞中炎性因子IL-1β和TNF-α的mRNA表达量及蛋白含量,推测其作用机制可能与抑制c-Fos/NLRP3/caspase-1级联反应有关。     

腹腔镜手术半开放置鞘气腹法安全建立气腹5 598例分析

目的:探讨腹腔镜手术半开放置鞘气腹法建立气腹的可行性及操作方法。方法:回顾分析5 600例腹腔镜术中半开放置鞘气腹法5 598例成功的经验及2例失败的教训。结果:5 600例中5 598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为99.96%。结论:半开放置鞘气腹法融合闭合法及开放法的优点,安全可行,操作简便。     

两种氧合器对心肺转流炎症反应的影响

目的动态监测室间隔缺损修补术患者在心肺转流(CPB)各时段血清可溶性细胞间粘附分子(sICAM-1)、可溶性E-选择素(sE-selection)及肿瘤坏死因子α(TNF-α)的变化规律,并比较西京-90鼓泡式氧合器和希健-Ⅱ膜式氧合器对其的影响。方法选择择期行室间隔缺损修补术的患者30例,随机均分为鼓泡式氧合器组(B组)和膜式氧合器组(M组)。所有患者分别在麻醉后CPB开始前(T1)、主动脉阻断开放前(T2)、CPB结束时(T3)、术后2h(T4)、6h(T5)、24h(T6)及48h(T7)取静脉血5ml用ELISA法测定sICAM-1、sE-selection及TNF-α的浓度。结果两组患者血清中的TNF-α于T2时开始显著升高,T4时达到峰值(P<0·01)。sICAM-1于T5时开始升高,T6时达峰值。sE-selection于T4时开始升高,T5时达峰值(P<0·01)。M组大部分时点TNF-α、sICAM-1、sE-selection的浓度均低于B组。结论希健-Ⅱ膜式氧合器引起的炎症反应较轻。     

Hand-assisted laparoscopic splenectomy for ruptured spleen

Although the laparoscopic technique is an accepted method for elective splenectomy, it is controversial in the setting of trauma. A few reports have described laparoscopic splenorrhaphy for trauma, but none have performed laparoscopic splenectomy for splenic rupture. When the spleen is injured, vascular control and poor visibility due to bleeding present obstacles to laparoscopy. The development of the hand-assist device has helped surgeons make the transition from laparotomy to laparoscopy because of the advantages it provides, such as tactile sensation and immediate vascular control. We utilized these benefits of the hand-assist device to convert a laparoscopic operation to a hand-assisted laparoscopic operation and were thus able to avoid a laparotomy. We report a case in which the hand-assist device was used as an alternative to conversion during a laparoscopic splenectomy for ruptured spleen.     

Inflammatory pseudotumour of the spleen associated with splenic tuberculosis

Inflammatory pseudotumor (IPT) of the spleen is an uncommon entity with an uncertain aetiology. Inflammatory pseudotumors present diagnostic difficulties because the clinical and radiological findings tend to suggest a malignancy. The symptoms include weight loss, fever, and abdominal pain. Most cases of splenic IPT present solitary relatively large well circumscribed masses on imaging. The diagnosis in the majority of the cases is made after histopathologic study of splenectomy specimens. The IPTs that occur in the spleen and liver are typically associated with Epstein-Barr virus. Thirty-seven percent of all new cases of active tuberculosis infection are extrapulmonary tuberculosis and tuberculous lymphadenitis the most commonly occurring form of extrapulmonary tuberculosis. We report the case of an inflammatory pseudotumor of the spleen associated with splenic tuberculous lymphadenitis in a 50-year-old female patient who was preoperatively diagnosed with a malignant spleen tumour based on her history of breast of carcinoma.     

帕瑞昔布钠联合镇痛对乳腺癌患者术后炎症及应激反应的影响

目的探讨帕瑞昔布钠联合镇痛对乳腺癌患者术后炎症和应激反应的影响。方法择期在全麻下行乳腺癌根治术患者60例,随机分为帕瑞昔布钠联合镇痛组(P组)和对照组(C组),每组30例。两组术后均采用布托啡诺行自控静脉镇痛。分别于术毕即刻、术后12、24、36h静注帕瑞昔布钠40mg(P组)和生理盐水5ml(C组)。用放免法测定血浆前列腺素E2(PGE2)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6及肾素、血管紧张素-Ⅱ(ANG-Ⅱ)、醛固酮(ALD)、皮质醇(Cor)浓度。结果术后12～48h,P组血浆PGE2、TNF-α、IL-6及肾素、ANG-Ⅱ、ALD、Cor浓度无明显变化,但在术后12、24h明显低于C组(P<0.05)。结论帕瑞昔布钠联合布托啡诺镇痛可减轻乳腺癌根治术患者术后的炎症反应和应激反应,有一定的免疫保护作用。     

异丙酚对创伤后全身炎症反应综合征患者炎性细胞因子的影响

目的：研究异丙酚对合并全身性炎症反应综合征（SIRS）的骨科创伤患者炎性细胞因子的影响。方法：将40例合并SIRS、麻醉前创伤评分≤13分、手术时间4h以内、估计累计出血量≥1000ml的骨科创伤患者随机分为两组（n=20）,两组均行切开复位内固定术,均采用静吸复合麻醉,全麻诱导方式相同,对照组给予依托咪酯0．2～0．3mg／kg静脉注射,异丙酚组给予异丙酚1．O～2．0mg／kg静脉注射,并术中维持,其余处理方法相同。分别于全麻诱导前、麻醉后5min、术毕、术后1d和7d检测血浆白细胞介素-1β（IL-1β）、IL-6、IL-8、肿瘤坏死因子-α（TNF—α）含量。结果：两组患者麻醉前炎性细胞因子水平差异无显著性;各组于麻醉后5min与诱导前比较亦无明显变化;术毕及术后1d两组炎性细胞因子均升高,但异丙酚组升高幅度较小,相同时间点两组间IL-6、IL-8、TNF—α差异有显著性（Pd0．05）;术后7d两组炎性细胞因子水平差异无显著性（P〉O．05）。结论：异丙酚对SIRS患者炎性细胞因子生成具有抑制作用,能在一定程度上抵抗机体过度炎性反应。     

3%高渗氯化钠对神经外科手术患者炎症反应的影响

目的观察3%高渗氯化钠对神经外科手术患者血浆炎症反应程度的影响。方法选择拟于全身麻醉下行幕上深部肿瘤切除术的患者50例,男30例,女20例,年龄18~65岁,ASAⅠ或Ⅱ级。运用电脑随机数字表将患者分为两组,每组25例。切皮前MT_组予以20%甘露醇1g/kg,HS组予以3%高渗氯化钠溶液2ml/kg,15min内滴注完毕。记录诱导前10min(T_0)、滴注3%高渗氯化钠溶液(MT_组为20%甘露醇)时(T_1)、滴注完成即时(T_2)、滴注完成后30 min(T_3)、60 min(T_4)的MAP、HR、尿量、颅内压(ICP)和脑灌注压(CPP),检测T_0~T_4时患者内环境及电解质水平,并记录苏醒时间和术中出血量;检测T_0~T_4时血浆T_NF-α、IL~(-1)β和IL-6水平。结果 T_2~T_4时HS组ICP明显低于MT_组,T_3、T_4时HS组尿量明显少于MT_组,HS组T_NF-α、IL-6和IL~(-1)β明显低于MT_组(P0.05)。结论与20%甘露醇比较,3%高渗氯化钠能更有力地抑制神经外科手术患者血浆炎症反应。     

脾脏炎性假瘤七例诊治报告

目的探讨脾脏炎性假瘤的临床诊断和治疗。方法回顾性分析2006年1月至2015年3月7例经手术和病理证实的脾脏炎性假瘤的临床资料以及结合文献探讨其CT表现。结果 7例病人中2例有外伤致脾脏包膜下血肿病史,病程较长,早期无自觉症状,其余病例均由体检发现脾脏占位,无特异性临床表现,均行脾脏切除术。术后定期随访均无并发症。结论脾脏炎性假瘤的治疗主要是通过手术,增强CT对脾脏炎性假瘤的诊断和鉴别诊断具有重要价值。     

Wandering spleen in children: multicenter retrospective study

Wandering spleen in children is a rare condition. The diagnosis is difficult, and any delay can cause splenic ischemia. An epidemiologic, semiological, and surgical diagnosis questionnaire on incidence of wandering spleen in children was sent to several French surgical teams. We report the results of this multicenter retrospective study.Fourteen cases (6 girls, 8 boys) were reported between 1984 and 2009; the age range varies between 1-day-old and 15 years; 86% were seen in the emergency department. Ninety-three percent had diffuse abdominal pain. For 57% of the cases, it was their first symptomatic episode of this type. No diagnosis was established based on the clinical results alone. All patients had presurgical imaging diagnosis. Open surgery was performed on 64% cases. Forty-three had splenectomy for splenic ischemia. Thirty-six percent had splenopexy, 14% had laparoscopic gastropexy, and 7% had spleen repositioning and regeneration. Complications were noted in 60% of the cases resulting in postsplenopexy splenic ischemia.Early diagnosis and surgery are the best guarantee for spleen preservation. Even if the choice of one technique, splenopexy or gastropexy, can be argued, gastropexy has the advantage of avoiding splenic manipulation and restoring proper physiologic anatomy. When there is no history of abdominal surgery, laparoscopy surgery seems the best procedure.     

削痂对深Ⅱ度烧伤局部IL-8释放及创面炎性反应的影响

目的评价削痂手术对深Ⅱ度烧伤创面局部 IL-8水平和炎性反应程度的影响。方法检测7例烧伤病人深Ⅱ度创面削痂手术前、手术后和未手术之创面组织在体外组织培养中释放 IL-8的水平,同时通过组织病理学观察创面局部炎性反应程度。结果削痴手术后创面组织释放 IL-8水平较手术前和未手术创面有显著降低.局部组织形态学观察亦显示,手术后创面的炎性反应较手术前有明显减轻,未手术创面除有大量中性粒细咆浸润外,坏死范围较手术前扩大,残留的少量皮肤附件因炎症扩大而消失。结论削痂手术能减少局部组织 IL-8的释放,改善炎性反应,对防止深Ⅱ度创面组织进行性加深有积极意义。