Effects Of Different Pneumoperitoneal Pressure On Vascular Endothelial Cell In Gynecological Laparoscopic Surgery

ObjectiveWith the continuous development of laparoscopy, its indications are getting extensively,such as huge gynecology benign tumor,pelvic lymphadenectomy in radical cystectomy and other complicated operations, can be completed in laparoscope. Deep vein thrombosis (DVT) is one of the complications, regrettably, the risk of venous thrombosis was underestimated, because the majority of venous thrombosis do not have clinical symptoms, once the clinical symptoms appears,the morbidity and mortality rate will be very high.Through to the determination of vascular endothelial cell injury markers,we observe the effects of different pneumoperitoneal pressure on vascular endothelial cell in gynecological laparoscopic surger, and evaluate the influences of different pneumoperitoneal pressure on the incidence of deep vein thrombus (DVT) postopertively.MethodsSixty patients who underwent gynecological laparoscopic surgery from October 2008 to June 2009 in Shengjing Hospital were selected as our subjects.All the subjects were diagnosed as benign ovarian tumor or single uterine fibroid, gradeⅠorⅡ,according to the American Society of Anesthesiologists (ASA)grading system, normal heart and lung fuction,age20to50 year (35.4±7.9), Weight of not more than 20% of standard body weight, no high risk factors of thrombogenesis (obesity, hypertension, coronary heart disease) and no blood diseases. Before the experiment, we establish the order in hospitalized time as patient sequence numbers forl to 60, which are ordinally endowned with random numbers,and sequence random numbers samll to big, then numbers from 1 to 20 is for the low pneumoperitonuem pressure group,numbers from 21 to 40 is for middle pneumoperitonuem pressure group,numbers from 41 to 60 is for high pneumoperitonuem pressure group. So we know which group patient should be in. The subjects were randomly allocated into one of three groups,twenty patients each:high pneumoperitonuem pressure group(15mmHg), middle pneumoperitonuem pressure group (13mmHg), low pneumoperitonuem pressure group(11mmHg), respectively, HP, MP, LP on behalf of. All operations are under the general anesthesia,in the same conditions and environment,and no postoperative complications occurred. The blood samples of all subjects were collected by pre-operation,intra-operation (30 min after the pneumoperitonuem started),post-operation(12h after operation), respectively to study changes of the parameters as follows:Thrombomodulin(TM),von Willebrand disease factor(vWF),P-selection(PS),all measured by enzyme linked immunosorbent assay.To observe the changes of vascular endothelial cell injury markers in different pneumoperitonuem pressures.The experimental data were analyzed by SPSS 13.0. Analysis of variance was used to compare the data of different pneumoperitoneum pressure groups,and the paired T test was used to compare data between the same group of different periods.Results1 TM,vWF,PS were increased significantly during the operation and after the operation(P<0.05).2.TM:Comparing with HP and MP, there is no statistical difference in intraoperative and postoperative data(P>0.05). The HP is apparently higher than the LP both intra-and post-operation(P<0.05), the MP is apparently higher than LP during operation(P<0.05)), but no statistically significant difference after operation(P>0.05).3.PS:Comparing with HP and MP, there is no statistical difference during and after operation (P>0.05). The HP is apparently higher than the LP both intra-and post-operation(P<0.05), the MP is apparently higher than LP during operation(P<0.05), but no statistically difference after operation(P>0.05).4 vWF:The HP is Significantly higher than LP both intra-and post-operation(P<0.05), HP and MP,MP and LP have no apparent difference during and after surgery.Conclusion1.The intraoperative and postoperative vascular endothelial cell injury markers were significantly higher than preoperative,which suggests the laparoscopic surgery with Carbon dioxide pneumoperitoneum can cause the injury of vascular endothelial cell.2.All the markers we measured were significantly increased in the HP comparing with LP, which suggests that lower the pressure of pneumoperitoneum, the less damage to the vascular endothelial cell, and help reduce the incidence of DVT.