| BackgroundEndometriosis (EMs) is a commonly observed disease in clinical gynecology. Prone to the disease are women in their reproductive years. The clinical manifestations include dysmenorrheal, chronic pelvic pain, pain during sexual intercourse, and infertility. The etiology of this disease remains elusive. Extensive studies on the nosogenesis of EMs in recent years have shown that adhesion, aggression and angiogenesis play vital roles in the occurrence and development of EMs. This study, based on explores the effect of laparoscope on the tissue of EMs lesions, observes the relative cellular and molecular mechanisms of rat EMs lesions Adhesion(CD44v6,CD44,ICAM-1), Aggression (MMP-2,TIMP-2) and Angiogenesis (VEGF-A,ENS).Part I Establishment of the endometrial lesion in a rat modelObjective:To appraise the establishment of two types of endormetrial lesion in the rat model as well as the feasibility of the application of such model in the study of endormetrial lesionMethods:10 female Wistar rats and 10 female SD rats, after random allocation, are injected estradiol benzoate (0.1ml/kg) to maintain the rats in estrus and their own endometriums were stitched to the two peritoneums The rats without model building are in the control group. In 4 weeks, the variety of the relative index of EMs lesion Adhesion, Aggression and Angiogenesis of both rat species are observed.Results:The peritoneum of both Wistar rats and SD rats developed ectopic focus. The means of the relative express value of CD44v6 and ICAM-1 in ectopic focus of Wistar rat model group are 3.32±0.18,4.44±0.11, the means of the relative express value of MMP-2, VEGF-A are 2.61±0.11,5.58±0.14, which are respectively 3.32,4.44,2.61,5.58 times of the control group (1.00±0.04,1.00±0.02,1.00±0.07,1.00±0.04) (P<0.05); the means of the relative express value of TIMP-2, ENS are 0.44±0.07,0.62±0.03, which are respectively 0.44 and 0.62 times of the control group (1.00±0.03,1.00±0.03) (P<0.05). The variety tendency of the above index in the ectopic focus of SD rat model group is the same to that in Wistar rat model. Conclusion:The models of two rat species could be used in the study of endormetrial lesion.Part II Effects of different pneumoperitoneum and different act time on the adhesion, aggression and angiogenesis of ectopic focus of endormetrial lesion in the rat modelObjective:To appraise the varying degrees of the effects of different pneumoperitoneum and different act time on the ectopic focus of endormetrial lesion, as well as the adhesion, aggression and angiogenesis factors.Methods:The model established rats were random allocated. CO2 pneumoperitoneum 30 minutes, CO2 pneumoperitoneum 1 hour, N2 pneumoperitoneum 1 hour were respectively performed, and no pneumoperitoneum interference performed to the control group. The relative express value and concentration of correlation factors (same with Patr I) in ectopic focus, serum and Adhesion, Aggression as well as Angiogenesis are examined 1 week,2 weeks, and 4 weeks following the pneumoperitoneum interference of the rats.Results:In 1 week of CO2 pneumoperitoneum 1 hour, the means of relative express value of CD44v6 and ICAM-1 in ectopic focus are 0.52±0.11,0.35±0.16, the means of relative express value of MMP-2 and VEGF-A 0.67±0.18,0.52±0.10, which are 0.52,0.35,0.67, 0.52 times of that in control group (1.00±0.02,1.00±0.03,1.00±0.03,1.00±0.03) (P< 0.05) and lower than those of CO2 pneumoperitoneum 30 minutes group (0.79±0.13, 0.79±0.08,0.67±0.18,0.75±0.21) (P<0.05); the the means of relative express value of TIMP-2 and ENS are 1.60±0.10,1.80±0.12, which are 1.6 and 1.8 times of that in the control group, and higher than those of the CO2 pneumoperitoneum 30 minutes group (1.34±0.05.1.75±0.08) (P<0.05). In 2 weeks and 4 weeks the relative index in the ectopic focus mainly returned to the level of control group. In 1 week of the interference of N2 pneumoperitoneum 1 hour, the means of relative express value of CD44v6,ICAM-1,MMP-2,VEGF-A in ectopic focus are 0.52±0.10,0.50±0.13,0.67±0.20,0.59±0.19, which are 0.52,0.50,0.67,0.59 times of those in the control group. (P< 0.05); the means of relative express value of TIMP-2,ENS are 1.57±0.04,1.74±0.04, which are 1.57 and 1.74 time of that in the control group. In 2 weeks and 4 weeks the relative index in the ectopic focus mainly returned to the level of control group.Conclusion:1. Both CO2 pneumoperitoneum and N2 pneumoperitoneum deter the adhesion, aggression and angiogenesis of ectopic focus, and the difference in deterrence is minimal.2. The longer the act time, the stronger the deterrence will be.3. In 2 weeks after the pneumoperitoneum interference the indexes return to the normal lever gradually, and in 4 weeks the indexes are close to the normal level.PartⅢEffects of CO2 pneumoperitoneum acting to different stages of model building on adhesion, aggression and angiogenesis on the of ectopic focus of endormetrial lesion.Objective:To discuss the effects of CO2 pneumoperitoneum on the early-stage endormetrial lesion focus in abdominopelvic cavity.Methods:Rats were built model and random allocated. According to the time pneumoperitoneum, the rats were divided into immediate (0 w) interference group,1 week after operation interference group,2 weeks after operation interference group and the control group without pneumoperitoneum interference.4 weeks after the operation the variety of each index of ectopic focus in different management groups and control group was observed.Results:The means of the relative express value of CD44v6, ICAM-1, MMP-2, VEGF-A in the immediate interference group are respectively 2.71±0.52,1.25±0.22,1.61±0.82, 2.15±0.92, which are much lower than those in the control group (10.03±1.33,4.79±1.26,12.50±6.27,8.82±3.47) (P<0.05); The means of the relative express value of TIMP-2,ENS are 0.62.±0.20,0.88.±0.41, which is much higher than those in the control group (0.16±0.07,0.38±0.09) (P<0.05). The tendency of the indexes of ectopic focus in the 1 week after operation interference group and 2 weeks after operation interference group are the same to those in the control group.Conclusion:CO2 pneumoperitoneum inhibits the adhesion, aggression and angiogenesis of the early-stage endormetrial lesion focus.Summary1. The models of two rat species could be used in the study of endormetrial lesion;2. CO2 pneumoperitoneum and N2 pneumoperitoneum both inhibit the adhesion, aggression and angiogenesis of ectopic focus, and the difference in inhibition is minimal;3. The longer the CO2 pneumoperitoneum lasts, the stronger the inhibition to cytokines; 4.2 weeks after the pneumoperitoneum interference, the indexes return to the normal level, and 4 weeks after the pneumoperitoneum interference, the indexes are close to the normal level.
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