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  

The effect of prolonged laparoscopic surgery on peritoneal mesothelial cells and fibrinolysis

作　　者：赵伟[1] 李晓婷[2] 李云东[2] 隋淑凤 谭春林[2] 刘在波[2] 刘莉[2] 王学萍[2] 王康[1] 纪明明[2] 

机构地区：[1]西安交通大学第一附属医院普外科,陕西西安710061 [2]海阳市人民医院,山东海阳265100

出　　处：《西安交通大学学报（医学版）》2017年第1期113-116,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

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。Objective To assess the effect of prolonged laparoscopic surgery on peritoneal mesothelial cells and fibrinolysis in humans. Methods We examined prospectively 16 consecutive patients who underwent laparoscopic surgery （LAP） and 21 patients who underwent conventional open surgery （OP） for high-medium rectal cancer with curative intent. During the procedure, biopsy of the parietal peritoneum was made before operation and at 45 min, 90 min, and 120 min after operation. The tissue-type plasminogen activator （tPA） and plasminogen activator inhibitor-1 （PAI-1） were determined by enzyme-linked immunosorbent assay in peritoneal tissues. The cellular injury was detected by LDH assay. The proliferation was quantified by MTT assay. Results PAI-1 activity in the peritoneal tissue was significantly lower in LAP group than in the OP group, tPA activity decreased after 45min of open surgery, but there was no significant change in the LAP group. With time extension, the LDH activity increased and the proliferation of the mesothelial cells decreased. Conclusion Preservation of a prolonged hypofibrinolytic state by inhibition of PAI-1 up-regulation during LAP may predispose patients to less postoperative peritoneal adhesion. The cellular injury becomes apparent and the proliferation is inhibited during prolonged laparoscopic surgery.

关 键 词：腹腔镜手术 纤维蛋白溶解作用 组织型纤溶酶原激活物抑制剂 腹膜粘连 间皮细胞 

分 类 号：R735.3[医药卫生—肿瘤]