Impact Of CO₂ Pneumoperitoneum On Peritoneal Microenvironment

Objective: A number of animal experiments have shown that CO2 pneumoperitoneum pressure, time will have an adverse impact on the peritoneal environment after laparoscopic operation. This study is a prospective clinical trial. The present experimental study investigates the impact of CO2 pneumoperitoneum time on human peritoneum.Methods: Normal human peritoneal tissues were collected at different time points(0 hours, 1 hours, 2 hours) of laparoscopic radical hysterectomy and(or) pelvic lymph node dissection operations. In order to ensure the homogeneity of the research object, the strict inclusion criterias were performed.At last this study collected 10 cases of human peritoneal tissues, a total of 30 peritoneal samples. Expression levels of three genes that encode extracellular matrix proteins, adhesion molecules or inflammatory cytokine signaling molecules were measured in peritoneal tissues using real-time fluorescent quantitative PCR method in the laboratory.Results: With the prolongation of CO2 pneumoperitoneum, the expression level of E-selectin, CTGF, HAS-1 of peritoneal tissue m RNA was significantly up-regulated, among them E-selectin, HAS-1 upregulation of m RNA trend as the amount of CO2 pneumoperitoneum duration is more and more obvious, the T2 group was significantly higher than that of T0 group(P < 0.01), and the differences between T1 groups have statistical significance(P < 0.05). But the extension of the expression level of CTGF m RNA in the peritoneal tissue with CO2 pneumoperitoneum gradually slowing down, the expression level of T1 in group CTGF was significantly higher than that of group T0(m RNA P<0.001), but no significant difference between groups(T2 and P=0.945).Conclusions: In the complicated laparoscopic procedures, with the consuming time of surgery, peritoneal tissues may express a variety of adhesion molecules, extracellular matrix proteins regulated by signal transduction channel. As a result, peritoneal microenvironment might induce more inflammatory reaction, play a potential role on peritoneal adhesion or even peritoneal metastasis. Therefore, it is essential to highlight the safety concern of laparoscopic surgery in clinical practice, through varity and effective clinical strategies to prevent the adverse effects of CO2 pneumoperitoneum.