腹腔镜手术时间延长对腹膜间皮细胞及纤维蛋白溶解活性的影响

发布时间：2018-05-20 19:06

本文选题：腹腔镜手术 + 纤维蛋白溶解作用　；参考：《西安交通大学学报(医学版)》2017年01期

【摘要】：目的探讨延长腹腔镜手术时间对人体腹膜间皮细胞及纤维蛋白溶解活性的影响。方法对16例拟行腹腔镜手术(腹腔镜组)和21例开腹手术(开腹组)的高中位直肠癌患者进行前瞻性研究。在手术开始及随后45、90、120min采集壁腹膜标本,采用ELISA法测定腹膜组织中组织型纤溶酶原激活物(tPA)和纤溶酶原激活物抑制剂(PAI-1)水平;培养大网膜间皮细胞,用乳酸脱氢酶法测定间皮细胞损伤情况,MTT法检测细胞增殖活性。结果腹腔镜组腹膜组织中PAI-1水平于手术45、90、120min时显著低于开腹组,开腹组tPA水平在手术45min显著降低,但在腹腔镜组未有明显改变;延长手术时间可引起腹腔镜组腹膜间皮细胞乳酸脱氢酶活性增加、增殖活性降低。结论腹腔镜手术通过抑制PAI-1增量调节,延长腹膜纤溶作用,减少术后并发腹膜粘连形成。腹腔镜延长手术时间可增加间皮细胞损伤、降低增殖活性。
[Abstract]:Objective to investigate the effect of prolonged laparoscopic surgery on peritoneal mesothelial cells and fibrinolytic activity. Methods A prospective study was carried out in 16 patients with middle and high rectal cancer undergoing laparoscopic surgery (laparoscopic group) and 21 patients undergoing open surgery (open group). The parietal peritoneal specimens were collected at the beginning of operation and 45 ~ 90min after operation. The levels of tissue plasminogen activator (TPA) and plasminogen activator inhibitor (PAI-1) in peritoneal tissue were measured by ELISA method, and the mesothelial cells of greater omentum were cultured. The damage of mesothelial cells was measured by lactate dehydrogenase assay. Results the level of PAI-1 in peritoneal tissue of laparoscopy group was significantly lower than that of open group at 45 ~ 90120min. The tPA level in laparotomy group was significantly lower than that in open group, but there was no significant change in laparoscopy group. Prolonging the operation time could increase the activity of lactate dehydrogenase and decrease the proliferative activity of peritoneal mesothelial cells in laparoscopic group. Conclusion Laparoscopic surgery can inhibit PAI-1 increment, prolong peritoneal fibrinolysis and reduce postoperative peritoneal adhesion. Prolonging the operation time by laparoscopy can increase the injury of mesothelial cells and decrease the proliferative activity.
【作者单位】：西安交通大学第一附属医院普外科;海阳市人民医院;
【分类号】：R656

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