• 南華大學附屬第二醫(yī)院普外科（湖南衡陽 421001）;

目的  研究腹腔鏡手術時CO2氣腹對Sprague-Dawley (SD)大鼠重癥急性胰腺炎（SAP）胰腺組織病理學改變、血淀粉酶、炎癥細胞因子（IL-1和IL-6）和可溶性黏附分子（CD11a/CD18和CD11b/CD18）的影響。
方法  雄性SD大鼠50只，隨機分為3組: CO2 氣腹組（n=20），5%?；悄懰徕c膽胰管逆行注射方法制備SAP動物模型后，以氣腹機向大鼠腹腔內(nèi)注入CO2〔壓力12 mm Hg (1 mm Hg=0.133 kPa)，維持30 min〕; SAP組（n=20）: 建立SAP模型后關腹，不充入CO2; 單純手術組（n=10）: 僅開腹翻動胰腺后關腹。各組均于術后2.5 h處死動物，取靜脈血測定血淀粉酶、IL-1和IL-6水平及CD11a/CD18和CD11b/CD18的表達陽性率，并進行胰腺組織病理學檢查。
結果  與單純手術組相比，CO2氣腹組和SAP組胰腺組織病理學評分、血清淀粉酶、IL-1和IL-6水平及CD11a/CD18和CD11b/CD18表達陽性率均明顯升高，差異有統(tǒng)計學意義（P=0.000）。與SAP組相比，CO2氣腹組血IL-1和IL-6水平明顯降低，差異有統(tǒng)計學意義（P=0.000）; 而胰腺組織病理學評分（P=0.294）、血清淀粉酶水平（P=0.073）、CD11a/CD18 （P=0.155）和CD11b/CD18 （P=0.201）表達陽性率的差異無統(tǒng)計學意義。
結論  對于SAP大鼠，CO2氣腹對IL-1和IL-6水平有一定的抑制作用; 而對胰腺病理變化及CD11a/CD18和CD11b/CD18表達陽性率無明顯影響。

引用本文： 賀紅杰,秦春宏,張學林,吳江. CO2氣腹對大鼠重癥急性胰腺炎胰腺病理及IL-1、IL-6、CD11a/CD18和CD11b/CD18的影響. 中國普外基礎與臨床雜志, 2010, 17(2): 147-151. doi: 復制

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1. 張圣道， 雷若慶. 指南后時代重癥急性胰腺炎外科治療的一些關鍵問題 [J]. 中國普外基礎與臨床雜志, 2007; 14(4): 381382.
2. Zhu JF, Fan XH, Zhang XH. Laparoscopic treatment of severe acute pancreatitis [J]. Surg Endosc, 2001; 15(10): 12391241.
3. 黃克儉, 花人放, 孔今城, 等. 靜脈輸注脂肪乳劑對急性壞死性胰腺炎大鼠脂質炎性介質的影響 [J]. 上海醫(yī)學, 1998; 21(12): 700702.
4. Yol S, Bostanci EB, Ozogul Y, et al. Effect of carbon dioxide pneumoperitoneum on the severity of acute pancreatitis: an experimental study in rats [J]. Surg Endosc, 2004; 18(12): 17471751.
5. Schmidt J, Lewandrowski K, Fernandezdel Castillo C, et al. Histopathologic correlates of serum amylase activity in acute experimental pancreatitis [J]. Dig Dis Sci, 1992; 37(9): 14261433.
6. Mofidi R, Patil PV, Suttie SA, et al. Risk assessment in acute pancreatitis [J]. Br J Surg， 2009; 96(2): 137150.
7. 余文， 吳偉， 張少輝， 等. 急性胰腺炎發(fā)病機理的研究進展 [J]. 中國普外基礎與臨床雜志, 2006; 13(6): 733736.
8. Bhatia M. Acute pancreatitis as a model of SIRS [J]. Front Biosci, 2009; 14: 20422050.
9. Jiang CF, Shiau YC, Ng KW, et al. Serum interleukin6, tumor necrosis factor alpha and Creactive protein in early prediction of severity of acute pancreatitis [J]. J Chin Med Assoc, 2004; 67(9): 442446.
10. Alfonsi P, VieillardBaron A, Coggia M,et al. Cardiac function during intraperitoneal CO2 insufflation for aortic surgery: a transesophageal echocardiographic study [J]. Anesth Analg, 2006; 102(5): 13041310.
11. Ure BM, Niewold TA, Bax NM, et al. Peritoneal, systemic, and distant organ inflammatory responses are reduced by a laparoscopic approach and carbon dioxide versus air [J]. Surg Endosc, 2002; 16(5): 836842.
12. Champault G, Cruaud P, Guilon P, et al. Is carbon dioxide responsible for the reduction in postoperative infections following laparoscopic surgery? [J]. Eur J Coelio Surg, 1997; 3: 3134.
13. Kopernik G, Avinoach E, Grossman Y, et al. The effect of a high partial pressure of carbon dioxide environment on metabolism and immune functions of human peritoneal cellsrelevance to carbon dioxide pneumoperitoneum [J]. Am J Obstet Gynecol, 1998; 179 (6 Pt 1): 15031510.
14. Luk JM, Tung PH, Wong KF, et al. Laparoscopic surgery induced interleukin6 levels in serum and gut mucosa: implications of peritoneum integrity and gas factors [J]. Surg Endosc, 2009; 23(2): 370376.
15. Novitsky YW, Czerniach DR, Kaban GK, et al. Immunologic effects of handassisted surgery on peritoneal macrophages: comparison to open and standard laparoscopic approaches [J]. Surgery, 2006; 139(1): 3945.
16. Duerr FM, Twedt DC, Monnet E. Changes in pH of peritoneal fluid associated with carbon dioxide insufflation during laparoscopic surgery in dogs [J]. Am J Vet Res, 2008; 69(2): 298301.
17. Sun W, Watanabe Y, Wang ZQ. Expression and significance of ICAM1 and its counter receptors LFA1 and Mac1 in experimental acute pancreatitis of rats [J].World J Gastroenterol, 2006; 12(31): 50055009.
18. Hughes SF, Hendricks BD, Edwards DR, et al. Mild episodes of tourniquetinduced forearm ischaemiareperfusion injury results in leukocyte activation and changes in inflammatory and coagulation markers [J]. J Inflamm (Lond), 2007; 4: 12.
19. Lan W, Harmon D, Wang JH, et al. The effect of lidocaine on neutrophil CD11b/CD18 and endothelial ICAM1 expression and IL1beta concentrations induced by hypoxiareoxygenation [J]. Eur J Anaesthesiol, 2004; 21(12): 967972.
20. Zhou MY, Lo SK, Bergenfeldt M, et al. In vivo expression of neutrophil inhibitory factor via gene transfer prevents lipopolysaccharideinduced lung neutrophil infiltration and injury by a beta2 integrindependent mechanism [J]. J Clin Invest, 1998; 101(11): 24272437.
  1. 1. 張圣道， 雷若慶. 指南后時代重癥急性胰腺炎外科治療的一些關鍵問題 [J]. 中國普外基礎與臨床雜志, 2007; 14(4): 381382.
  2. 2. Zhu JF, Fan XH, Zhang XH. Laparoscopic treatment of severe acute pancreatitis [J]. Surg Endosc, 2001; 15(10): 12391241.
  3. 3. 黃克儉, 花人放, 孔今城, 等. 靜脈輸注脂肪乳劑對急性壞死性胰腺炎大鼠脂質炎性介質的影響 [J]. 上海醫(yī)學, 1998; 21(12): 700702.
  4. 4. Yol S, Bostanci EB, Ozogul Y, et al. Effect of carbon dioxide pneumoperitoneum on the severity of acute pancreatitis: an experimental study in rats [J]. Surg Endosc, 2004; 18(12): 17471751.
  5. 5. Schmidt J, Lewandrowski K, Fernandezdel Castillo C, et al. Histopathologic correlates of serum amylase activity in acute experimental pancreatitis [J]. Dig Dis Sci, 1992; 37(9): 14261433.
  6. 6. Mofidi R, Patil PV, Suttie SA, et al. Risk assessment in acute pancreatitis [J]. Br J Surg， 2009; 96(2): 137150.
  7. 7. 余文， 吳偉， 張少輝， 等. 急性胰腺炎發(fā)病機理的研究進展 [J]. 中國普外基礎與臨床雜志, 2006; 13(6): 733736.
  8. 8. Bhatia M. Acute pancreatitis as a model of SIRS [J]. Front Biosci, 2009; 14: 20422050.
  9. 9. Jiang CF, Shiau YC, Ng KW, et al. Serum interleukin6, tumor necrosis factor alpha and Creactive protein in early prediction of severity of acute pancreatitis [J]. J Chin Med Assoc, 2004; 67(9): 442446.
  10. 10. Alfonsi P, VieillardBaron A, Coggia M,et al. Cardiac function during intraperitoneal CO2 insufflation for aortic surgery: a transesophageal echocardiographic study [J]. Anesth Analg, 2006; 102(5): 13041310.
  11. 11. Ure BM, Niewold TA, Bax NM, et al. Peritoneal, systemic, and distant organ inflammatory responses are reduced by a laparoscopic approach and carbon dioxide versus air [J]. Surg Endosc, 2002; 16(5): 836842.
  12. 12. Champault G, Cruaud P, Guilon P, et al. Is carbon dioxide responsible for the reduction in postoperative infections following laparoscopic surgery? [J]. Eur J Coelio Surg, 1997; 3: 3134.
  13. 13. Kopernik G, Avinoach E, Grossman Y, et al. The effect of a high partial pressure of carbon dioxide environment on metabolism and immune functions of human peritoneal cellsrelevance to carbon dioxide pneumoperitoneum [J]. Am J Obstet Gynecol, 1998; 179 (6 Pt 1): 15031510.
  14. 14. Luk JM, Tung PH, Wong KF, et al. Laparoscopic surgery induced interleukin6 levels in serum and gut mucosa: implications of peritoneum integrity and gas factors [J]. Surg Endosc, 2009; 23(2): 370376.
  15. 15. Novitsky YW, Czerniach DR, Kaban GK, et al. Immunologic effects of handassisted surgery on peritoneal macrophages: comparison to open and standard laparoscopic approaches [J]. Surgery, 2006; 139(1): 3945.
  16. 16. Duerr FM, Twedt DC, Monnet E. Changes in pH of peritoneal fluid associated with carbon dioxide insufflation during laparoscopic surgery in dogs [J]. Am J Vet Res, 2008; 69(2): 298301.
  17. 17. Sun W, Watanabe Y, Wang ZQ. Expression and significance of ICAM1 and its counter receptors LFA1 and Mac1 in experimental acute pancreatitis of rats [J].World J Gastroenterol, 2006; 12(31): 50055009.
  18. 18. Hughes SF, Hendricks BD, Edwards DR, et al. Mild episodes of tourniquetinduced forearm ischaemiareperfusion injury results in leukocyte activation and changes in inflammatory and coagulation markers [J]. J Inflamm (Lond), 2007; 4: 12.
  19. 19. Lan W, Harmon D, Wang JH, et al. The effect of lidocaine on neutrophil CD11b/CD18 and endothelial ICAM1 expression and IL1beta concentrations induced by hypoxiareoxygenation [J]. Eur J Anaesthesiol, 2004; 21(12): 967972.
  20. 20. Zhou MY, Lo SK, Bergenfeldt M, et al. In vivo expression of neutrophil inhibitory factor via gene transfer prevents lipopolysaccharideinduced lung neutrophil infiltration and injury by a beta2 integrindependent mechanism [J]. J Clin Invest, 1998; 101(11): 24272437.