不同气腹压对结直肠癌根治术患者内皮细胞形态的影响OA

Objective To investigate the effects of low-pressure pneumoperitoneum(LPP)(10 mmHg)versus standard-pressure pneumoperitoneum(SPP)(14 mmHg)on the microscopic structure of greater omentum capillaries,inflammatory factors,oxidative stress,and perioperative physiological function in patients undergoing laparoscopic radical resection of colorectal carcinoma(CRC).Methods A prospective randomized study was conducted.A total of 63 patients scheduled for laparoscopic radical resection of CRC from January 2022 to August 2023 were enrolled and randomly divided into the LPP group(n=31)and the SPP group(n=32)using a random number table.Specimens were collected from a standardized area of the greater omentum immediately after pneumoperitoneum establishment and five minutes before abdominal closure.Transmission electron microscopy was used to observe the thickness of capillary endothelial cell walls,the incidence of discontinuous cell membranes,and the number of autophagolysosomes.Inflammatory factors and oxidative stress indicators were monitored,while hemodynamic and respiratory mechanics parameters were recorded.The number of additional analgesic administrations within 48 hours postoperatively was also assessed.Results Compared with the LPP group,the SPP group showed increased capillary endothelial cell wall thickness 5 minutes before abdominal closure,a higher incidence of discontinuous cell membranes,and a greater number of autophagolysosomes;The SPP group also exhibited higher IL-6 levels 5 minutes before abdominal closure and 24 hours postoperatively;Higher malondialdehyde(MDA)and lower superoxide dismutase(SOD)levels 5 minutes before abdominal closure,and lower reduced glutathione(GSH)levels at 24 hours postoperatively;At all time points after pneumoperitoneum establishment,the mean airway pressure(Pmean)was significantly higher in the SPP group;Additionally,the number of rescue analgesic administrations 48 hours postoperatively was significantly more in the SPP group,the differences were statistically significant(P<0.05).Conclusion In laparoscopic radical resection of CRC,LPP may help alleviate ultrastructural damage to greater omentum capillary endothelial cells,reduce inflammation and oxidative stress,improve intraoperative respiratory mechanics,and decrease early postoperative analgesic requirements compared with SPP.It has certain clinical application value.