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目的了解应用CO2气腹的妇科腹腔镜手术在不同手术时间对人体腹膜结构的影响。方法将40例子宫肌瘤患者及40例卵巢良性肿瘤患者随机实行传统开腹手术(开腹手术组,n=35)和腹腔镜手术(腹腔镜手术组,n=45),分别于手术起始(腹腔镜手术起始时间为腹腔充气完毕,脐部及手术中一操作孔进入戳卡后)、手术30 min、60 min及手术结束时对壁层腹膜进行采取,应用光学显微镜及透射电镜(TEM)观察各手术时间腹膜结构变化,主要观察间皮细胞形态学变化。结果腹腔镜手术组在气腹充气完成后,间皮细胞立即出现肿胀,手术30 min时,细胞间连接表现出断裂,伴随基底裸露的现象。随着充气时间的延长,细胞肿胀明显,线粒体等细胞器肿胀明显,可见淋巴细胞和巨噬细胞,手术结束时,间皮细胞全部肿胀,且可见细胞破裂,微绒毛也出现肿胀、分离。开腹手术组各个手术时间间皮细胞无明显变化,细胞形态保持正常,基底膜完整,仅在关腹前偶见肿胀的间皮细胞。结论妇科腹腔镜手术中CO2气腹可明显改变腹膜结构,手术时间越长,腹膜损伤越严重。
Objective To understand the effect of pneumoperitoneum pneumoperitoneum laparoscopic surgery on human peritoneal structure at different operation time. Methods 40 patients with uterine fibroids and 40 patients with benign ovarian tumors underwent traditional laparotomy (laparotomy, n = 35) and laparoscopic surgery (laparoscopic surgery, n = 45) At the beginning of laparoscopic operation, the abdominal peritoneum was taken after 30 minutes, 60 minutes of operation and the end of surgery. The optical microscope and transmission electron microscope (TEM) to observe the change of peritoneal structure at each operation time, mainly observe the morphological changes of mesothelial cells. Results In the laparoscopic group, the mesothelial cells swelled immediately after the pneumoperitoneum was inflated. At 30 min of operation, the intercellular junctions showed a rupture accompanied by the bare basement. With the extension of inflating time, the cell swelling was obvious. The organelles such as mitochondria swelled obviously. Lymphocytes and macrophages were visible. At the end of the operation, the mesothelial cells were all swollen and the cells were disrupted. The microvilli also swollen and separated. In the laparotomy group, there was no obvious change of the dermal cells in each operation time, the morphology of the cells remained normal, the basement membrane was intact, and the swollen mesothelial cells were occasionally seen only in the abdomen. Conclusion CO2 pneumoperitoneum in gynecological laparoscopic surgery can significantly change the peritoneal structure. The longer the operation time, the more severe the peritoneal injury.