| Objective: Carbon dioxide pneumoperitoneum is one of the most important procedures in laparoscopic surgery. It often affects the stabilization of internal environment and the function of internal organs by mechanical or chemical mechanisms. This investigation is to study the effects of carbon dioxide pneumoperitoneum on islet cells's function in laparoscopic cholecystectomy through determining the concentration of plasma C-peptide and glucagon in different given time.Methods: Twenty ASAI-II patients undergoing elective cholecystectomy were randomly devided into two groups under general anaesthesia, laparoscopic cholecystectomy (LC) and open cholecystectomy (OC), Group LC as a study group and Group OC as a control group. A standard anaesthesia was given involving induction, intubation and mechanical ventilation. Anaesthesia was maintained with fentanil, vecuronium bromide and 1%-2% isoflurane. Blood samples were taken before operation (T1), 10 min after CO2 pneumoperitoneum (T2), 25 min after CO2 pneumoperitoneum (T3) and 15 min after deflation (T4) in Group LC; before operation (T1), open peritoneum (T2), after removed gallbladder (T3) and after operation (T4) in Group OC. The concentration of plasma C-peptide and glucagon was measured.Results: The first, the change of glucagon level in two groups:The preoperative level of glucagon was similar in both groups (P >0.05); At T2, the concentration of plasma glucagon increased in both groups compared with the preoperative level, it had no significant difference (P>0.05); Plasma glucagon concentration at T3 and T4 increased significantly compared with the preoperative data in Group LC (P<0.05); The concentration of plasma glucagon at T4 was lower than that at T3 in Group LC, but it had no significant difference (P>0.05); The concentration of plasma glucagon at T3 and T4 increased obviously compared with the level at T1 and T2 in Group OC (P<0.05); Glucagon level in Group LC was much lower than that in Group OC at T3 and T4 (P<0.05).The second, the change of C-peptide level in two groups: The preoperative level of C-peptide was similar in both groups (P>0.05); The concentration of plasma C-peptide increased in LC, it had significant difference at T3 and T4 compared with the preoperative level (P<0.05); Plasma C-peptide concentration at T3 and T4 decreased significantly compared with the preoperative data in Group OC (P<0.05).The concentration of plasma C-peptide at T3 and T4 in Group LC was much higher compared with Group OC (P<0.05).Discussion: Pneumoperitoneum is needed to separate abdominal wall from abdominal organs to make LC performed easily and clearly. Nowadays, Carbon dioxide (CO2) is generally used in pneumoperitoneum for laparoscopy undergoing charging operation, while it might cause some specific complications after laparoscopy.We can observe that in our study, the level of plasma glucagon was increasing during the operation in Group LC. The reasons may be: Laparoscopy itself is a stimulus to humen body; Carbon dioxide irritates the neuroendocrine system; The increasing of intra-abdominal pressure and intracranial pressure. The concentration of plasma glucagon in Group LC was much lesser at T3 and T4 compared with Group OC. We can conclude that the function of islet changed little in Group LC.Usually, the function ofβ-cell is inhibited during surgery. But in our study, the concentration of C-peptide in plasma increased in Group LC. The level was much higher at T3 and T4 in Group LC compared with the preoperative level. The reason may be: The decreasing of catecholamine compared with OC; The excitation of vagus nerve; The increasing of gut hormone. Carbon dioxide pneumoperitoneum make a less influence onβ-cell.Conclusion: This investigation through determining the concentration of plasma glucagon and C-peptide in different given time in laparoscopic cholecystectomy and open cholecystectomy suggests that CO2 pneumoperitoneum in laparoscopic surgery affects the function of islet cells much more poorly compared with the open surgery.
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