【摘要】 目的:探讨在模拟腹腔镜肾部分切除术(laparoscopic partial nephrectomy,LPN)环境下不同CO2气腹压力对大鼠肾缺血再灌注损伤的影响。方法:模拟LPN建立操作模型,将40只雄性Wistar大鼠平均分为4组:无气腹预处理组(NPre组),低压气腹预处理组(LPre组),中压气腹预处理组(MPre组)和高压气腹预处理组(HPre组),气腹预处理压力分别为0、5、10和15mmHg。气腹预处理方式为供气10min、放气10min,在10min放气阶段行开腹、暴露肾蒂血管等操作;随后夹闭左肾蒂血管并关腹,给予10mmHg的持续供气。术中各组大鼠完全阻断左肾血供45min,于再灌注24h时间节点切取左肾,比较各组大鼠肾小管损伤评分及氧化损伤指标超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)、总抗氧化能力(T-AOC)和丙二醛(MDA)的变化。结果:NPre组大鼠肾脏出现严重的缺血再灌注损伤,与LPre组的损伤程度差异无统计学意义(P>0.05),而MPre组和HPre组的损伤程度明显减轻(P<0.05);MPre组和HPre组大鼠肾脏损伤程度差异无统计学意义(P>0.05)。结论:经过45min的血流阻断,大鼠肾组织出现了严重的缺血再灌注损伤;低压气腹预处理不能减轻损伤,中压和高压气腹预处理则可显著提高肾组织对缺血的耐受性。气腹预处理可作为LPN术中减轻肾缺血再灌注损伤的有效方法。更多还原

【Abstract】 Objective:To discuss the effect of different pressure CO2 pneumoperitoneum upon renal ischemia-reperfusion injury (IRI) in laparoscopic partial nephrectomy (LPN) model of rat.Methods:One model referring to LPN was established.Forty male Wistar rats were distributed into four groups randomly and equally.Except for NPre group,all rats were treated by ischemic preconditioning (IP) of CO2 pneumoperitoneum,which were called LPre group,MPre group and HPre group respectively according to the pressure (5,10,15mm Hg) of pneumoperitoneum.The pattern of IP was 10 minutes of insufflation followed immediately by 10 minutes of deflation.During the 10 minutes deflation,the rat abdominal cavity was opened,the renal pedicle vessel was separated,the left renal pedicle blood vessel was clipped,and then the abdomen was closed.Pneumoperitoneum was given at the pressure of 10mm Hg.Rats were subjected to 45 minutes of left renal ischemia.After 24h of reperfusion the rats were sacrificed and left kidneys were excised.Kidney samples were tested for superoxide dismutase (SOD),glutathione peroxidase (GSH-PX),total anti-oxidation capability (T-AOC) and malondialdehyde (MDA).Besides,histopathologic differences about IRI of kidney tissue were assessed by experienced pathologists.Results:Kidneys of NPre group had severe IRI.Compared with NPre group,there was no significant difference of renal injury in LPre group(P>0.05),but MPre group and HPre group had more optimistic data in biochemical indicators and histopathologic outcome(P<0.05).Meanwhile,no statistical significance was found between MPre group and HPre group(P>0.05).Conclusions:It is found that 45min of clamping renal pedicle results in severe IRI in rats.IP arising from low pressure CO2 pneumoperitoneum can not relieve such injury,but middle and high pressure pneumoperitoneum IP can improve tolerance of kidney against IRI.IP of CO2 pneumoperitoneum could become an effective method against IRI in LPN.更多还原