The Impact Of Carbon Dioxide Pneumoperitoneum On Erythrocyte Immunity In Laparoscopy

Achieving the goal of treatment with minimum wound and maximum reduction of operation impact on human body is the direction of mordern surgery. Laparoscopic surgery has more advantage over traditional open surgery, such as less injury , shorter time of recovery and less pain,it is regarded as one of the tendency of surgery development. With the application of laparoscopy is expanded, many operations can be done by it, including the malignant tumor excision. With the more and more cases about occurrence of peritoneal carcinomatosis, residual tumor proliferation and port-site metastasis were reported, researchers devote themselves to study the possible mechanisms of this phenomenon. Since most laparoscopic procedures are done under CO₂ pneumoperitoneum , the influence of CO₂ pneumoperitoneum on the tumor cell dissemination and seeding receives extensive concern, but the mechanism remains unclear. The subject of this study is to observe the change of erythrocyte immunity of patients with benigh ovarian tumor undergoing laparoscopic operation. We investigate the possible factor of tumor cell's metastasis through this study , which could help us to evaluate the feasibility of CO₂ penumoperitoneum laparoscope used in malignant tumor surgeries and provide us the theoretical foundation of its application.MethodsFrom Apr 2004 to Nov 2004, in the department of Gynecology and Obstetrics of the Third Affliated Hospital of Zhengzhou University, Thirty-two otherwise health women with benigh ovarian tumor undergoing laparoscopic operation were studied in a prospective clinical trial. The blood samples were taken at pre-pneumoperitoneumâ– > 10 minutes during pneumoperitoneuniN 40 minutes during pneumoperitoneuirK 10 minutes after pneumoperitoneum to measure the erythrocyte immunity index including RC3bRR (the rosette rate of RBC-C3b receptor) > RICR( the complex rosette rate of red blood cell^ NTERR (the natural tumor erythrocyte rosette rate) n RFER( the complement receptor immune regulation enhance factor) -. RFIR (the complement receptor immune regulation inhiditor factor), the levels of serum P -endorphin at different period of time were detected through Radioimmunoassay . All of these were compared with twenty cases of normal control group. The results were analyzed by SPSS10.0 software.Results1. The RC3bRR of pre-pneumoperitoneum ^ 10 minutes during pneumoperitoneum ^ 40 minutes during pneumoperitoneum and 10 minutes after pneumoperitoneum in operation group were significantly lower than normal control group(P<0.05). No significance in RICR between pre-pneumoperitoneum and normal control group(P>0.05), obvious differences in RICR between other pneumoperitoneum group and control group(P<0.05). The NTERR of pre-pneumoperitoneum ^ 10 minutes during pneumoperitoneum % 40 minutes during pneumoperitoneum and 10 minutes after pneumoperitoneum were lower than control group, the differences were significant(P<0.05). Compared with pre-pneumoperitoneum , RC3bRR^ NTERR were lower in the other three pneumoperitoneum group(p<0.05),while RICR were higher(P<0.05). No differences between the lOmin during pneumoperitoneum group and lOmin after pneumoperitoneum,but their RC3bRR^ NTERR were higher than thatof the 40min during pneumoperitoneum group(P<0.05), while RICR were lower(P<0.05)2. The RFER of pre-pneumoperitoneum ^ 10 minutes during pneumoperitoneum > 40 minutes during pneumoperitoneum and 10 minutes after pneumoperitoneum in operation group were significantly lower than normal control group(P<0.05). No significance in RFIR between pre-pneumoperitoneum and normal control group(P>0.05), while the RFIR of 10 minutes during pneumoperitoneum > 40 minutes during pneumoperitoneum and 10 minutes after pneumoperitoneum were higher than the pre-pneumoperitoneum and normal control group (P<0.05). The RFER in 10 minutes during pneumoperitoneum were slightly higher than it in 10 minutes after pneumoperitoneum, while RFIR were a little lower(P<0.05). The RFER in 40 minutes during pneumoperitoneum were the lowest and the RFIR were the highest (P<0.05).3. The level of serum P -endorphin in pre-pneumoperitoneum had no significant difference compared with those in control group(P>0.05). The level of serum P -endorphin in 10 minutes during pneumoperitoneum, 40 minutes during pneumoperitoneum and 10 minutes after pneumoperitoneum were higher than the pre-pneumoperitoneum and normal control group (P<0.05). It was the highest in 40 minutes during pneumoperitoneum among others(P<0.05). The level of serum P -endorphin in 10 minutes after pneumoperitoneum were slightly higher than those in 10 minutes during pneumoperitoneum,but the change had no difference between the two groups(P>0.05). High level of P -endorphin could restrain the immune function of red blood cell. With the increase of serum P -endorphin concentration ,the RC3bRR, NTERR decreased while the RICR increased. The former had sinificantly negative correlation with serum P -endorphin concentration while the latter had sinificantly positive correlation with serum P -endorphin concentration.Conclusions1. Carbon dioxide pneumoperitoneum can suppress erythrocyte immune function in laparoscopy. The immunoadhesion function of erythrocyte decreased.2. Carbon dioxide pneumoperitoneum can cause the increase of serum P -endorphin concentration through neuro-endocrine stimulation.3. P -endorphin had dual regulation of erythrocyte immunological function. The low level of 3 -endorphin promoted erythrocyte immunological function while the high concentration of P -endorphin restrained erythrocyte immunological function.4. The suppressive effect of carbon dioxide pneumoperitoneum on erythrocyte immunological function would possibly be one of the reasons about the occurrence of peritoneal carcinomatosis> residual tumor proliferation and port-site metastasis in malignant tumor laparoscopy.