不同气腹压对结直肠癌根治术患者内皮细胞形态的影响

Effects of varying pneumoperitoneum pressures on endothelial cell morphology in patients undergoing radical resection of colorectal carcinoma

摘要:

目的 探讨低气腹压（LPP）（10 mmHg）与标准气腹压（SPP）（14 mmHg）对腹腔镜结直肠癌（CRC）根治术患者腹腔大网膜毛细血管内皮细胞形态结构、炎症因子、氧化应激反应及围手术期生理功能的影响。方法 采用前瞻性随机对照试验，纳入2022年1月－2023年8月于该院择期行腹腔镜CRC根治术的患者63例，采用随机数表法分为LPP组（n = 31）和SPP组（n = 32）。分别于气腹建立即刻和关腹前5 min取带毛细血管的大网膜标本，透射电镜下观察大网膜毛细血管内皮细胞血管壁厚度、细胞膜不连续发生率及自噬溶酶体的数量；同时监测炎症因子和氧化应激指标，记录血流动力学指标和呼吸力学参数，以及术后48 h镇痛药物追加次数。结果 与LPP组相比，SPP组关腹前5 min毛细血管内皮细胞厚度增加，细胞膜不连续发生率较高，自噬溶酶体数量增多；关腹前5 min和术后24 h的白细胞介素-6（IL-6）水平较高，关腹前5 min的丙二醛（MDA）较高，超氧化物歧化酶（SOD）较低；术后24 h的还原型谷胱甘肽（GSH）较低；气腹建立后各时点的平均气道压（Pmean）增高，术后48 h补救镇痛次数更多，差异均有统计学意义（P < 0.05）。结论 在腹腔镜CRC根治术中，LPP较SPP有助于减轻大网膜毛细血管内皮细胞损伤，减轻炎症反应和氧化应激反应，改善术中呼吸力学，减少术后早期镇痛需求，具有一定的临床应用价值。

Abstract:

Objective To investigate the effects of low-pressure pneumoperitoneum (LPP) (10 mmHg) versus standard-pressure pneumoperitoneum (SPP) (14 mmHg) on the microscopic structure of greater omentum capillaries, inflammatory factors, oxidative stress, and perioperative physiological function in patients undergoing laparoscopic radical resection of colorectal carcinoma (CRC).Methods A prospective randomized study was conducted. A total of 63 patients scheduled for laparoscopic radical resection of CRC from January 2022 to August 2023 were enrolled and randomly divided into the LPP group (n = 31) and the SPP group (n = 32) using a random number table. Specimens were collected from a standardized area of the greater omentum immediately after pneumoperitoneum establishment and five minutes before abdominal closure. Transmission electron microscopy was used to observe the thickness of capillary endothelial cell walls, the incidence of discontinuous cell membranes, and the number of autophagolysosomes. Inflammatory factors and oxidative stress indicators were monitored, while hemodynamic and respiratory mechanics parameters were recorded. The number of additional analgesic administrations within 48 hours postoperatively was also assessed.Results Compared with the LPP group, the SPP group showed increased capillary endothelial cell wall thickness 5 minutes before abdominal closure, a higher incidence of discontinuous cell membranes, and a greater number of autophagolysosomes; The SPP group also exhibited higher IL-6 levels 5 minutes before abdominal closure and 24 hours postoperatively; Higher malondialdehyde (MDA) and lower superoxide dismutase (SOD) levels 5 minutes before abdominal closure, and lower reduced glutathione (GSH) levels at 24 hours postoperatively; At all time points after pneumoperitoneum establishment, the mean airway pressure (Pmean) was significantly higher in the SPP group; Additionally, the number of rescue analgesic administrations 48 hours postoperatively was significantly more in the SPP group, the differences were statistically significant (P < 0.05).Conclusion In laparoscopic radical resection of CRC, LPP may help alleviate ultrastructural damage to greater omentum capillary endothelial cells, reduce inflammation and oxidative stress, improve intraoperative respiratory mechanics, and decrease early postoperative analgesic requirements compared with SPP. It has certain clinical application value.