【Abstract】ObjectiveTo investigate the influence of CO2 pneumoperitoneum on intestinal mucosa permeability in rats with liver cirrhosis. MethodsFifty rats were randomly divided into following groups: control group (n=5), cirrhosis group(n=5) and pneumoperitoneum group (n=40); the pneumoperitoneum group was further divided into 8 mm Hg group(n=20) and 13 mm Hg group (n=20). Four time points were chosen, including 0.5, 2, 6, and 12 hours after the end of pneumoperitoneum. After rat models with cirrhosis were established successfully, the abdominal cavity was insufflated with CO2 and maintained under the pressures of 8 mm Hg and 13 mm Hg respectively for two hours. The portal venous blood was collected and the levels of Dlactic acid and endotoxin were measured. ResultsThe levels of endotoxin and Dlactic acid in cirrhosis group were much higher than those of control group（P＜0.05）. The levels of serum endotoxin and Dlactic acid in pneumoperitoneum group were higher than those of cirrhosis group(Plt;0.05) regardless of pressure and time point. The endotoxin level in 13 mm Hg group was higher than that of 8 mm Hg group on different time points (F=5.466, P＜0.05), but there was no difference in Dlactic acid level between both of them（F=0.415,Pgt;0.05）.ConclusionThe intestinal mucosa permeability is increased in rats with liver cirrhosis. It can be further increased under CO2 pneumoperitoneum with certain pressure and time and in a pressuredependent manner. The permeability can decrease after removal of pneumoperitoneum.
【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.
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.
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.