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Effects of pneumoperitoneum of laparoscopic cholecystectomy on the coagulation system of patients： a prospective observational study

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Chinese Medical Journal 2014年第14期127卷 2599-2604页

作者： Amin Buhe Zhang Chengcai Yan Wei Sun Zhipeng Zhang Yankai Du Dexiao Gong Ke Capital Med Univ Dept Gen Surg Beijing Shijitan Hosp Beijing 100038 Peoples R China Zibo Cent Hosp Dept Laparoscopy Surg Zibo 255036 Shandong Peoples R China

BacKground Laparoscopic cholecystectomy has been widely used in clinical practice during the recent decades; however, the effects of pneumoperitoneum and the surgery on the coagulation system are largely unknown. This clinical study aimed to observe any possible effects of pneumoperitoneum and the surgery on the coagulation system of patients. Methods This was a prospective observational study. The inclusion criteria included （1） patients with chronic cholecystitis and/or cholecystic polyps and （2） patients in the relief stage of acute cholecystitis. The exclusion criteria included （1） patients in the episodic stage of acute cholecystitis and those complicated with cholangiolithiasis; （2） patients with concomitant hematologic diseases, damages to the liver function, malignant tumors or immune system diseases, or patients complicated with thrombotic or hemorrhagic disorders; and （3） patients who had taken anticoagulant medication within a week before surgery. Fifty patients who were hospitalized into our department for elective laparoscopic cholecystectomy between November 2011 and February 2013 were eligible and enrolled into this study. Of the 50 patients, 22 were male and 28 female. The age of the patients ranged from 29 to 78 （mean 56.7±11.5） years. The surgery for each of the 50 patients was performed with the same equipment and conditions. The surgeries for all the patients were performed under general anesthesia with the patients in a 30-degree head-up tilted posture, and the pressure of pneumoperitoneum was maintained at 13 mmHg. Venous blood specimens were taken from each patient before and at the end of pneumoperitoneum （i.e., 0 hour after surgery） and at 8 hours after surgery for determination of prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fib）, thrombin time （TT）, and D-dimer （DD）. The results of the determinations of these parameters were compared. Results （1） All the patients recovered well without any complications.

关键词： pneumoperitoneum cholecystectomy laparoscopic coagulation system

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Inhibitory effects of carbon dioxide insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy

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World Journal of Gastroenterology 2012年第27期18卷 3565-3570页

作者： Shinji Nishiwaki Hiroshi Araki Motoshi Hayashi Jun Takada Masahide Iwashita Atsushi Tagami Hiroo Hatakeyama Takao Hayashi Teruo Maeda Koshiro Saito Department of Internal Medicine Nishimino Kosei HospitalGifu 503-1394Japan Department of Gastroenterology Graduate School of MedicineGifu UniversityGifu 501-1194Japan

AIM:To evaluate the inhibitory effects of carbon dioxide (CO2) insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy (PEG).METHODS:A total of 73 consecutive patients who were undergoing PEG were enrolled in our *** eliminating 13 patients who fitted our exclusion criteria,60 patients were randomly assigned to either CO2 (30 patients) or air insufflation (30 patients) *** was performed by pull-through technique after threepoint fixation of the gastric wall to the abdominal wall using a gastropexy *** blood gas analysis was performed immediately before and after the *** X-ray was performed at 10 min and at 24 h after PEG to assess the extent of bowel *** computed tomography was performed at 24 h after the procedure to detect the presence of *** outcomes of PEG for 7 d postprocedure were also ***:Among 30 patients each for the air and the CO2 groups,PEG could not be conducted in 2 patients of the CO2 group,thus they were *** of the remaining 58 patients showed that the patients' backgrounds were not significantly different between the two *** elevation values of arterial partial pressure of CO2 in the air group and the CO2 group were 2.67 mmHg and 3.32 mmHg,respectively (P = 0.408).The evaluation of bowel distension on abdominal X ray revealed a significant decrease of small bowel distension in the CO2 group compared to the air group (P < 0.001) at 10 min and 24 h after PEG,whereas there was no significant difference in large bowel distension between the two *** was observed only in the air group but not in the CO2 group (P = 0.003).There were no obvious differences in the laboratory data and clinical outcomes after PEG between the two ***:There was no adverse event associated with CO2 ***2 insufflation is considered to be safer and more comfortable for PEG patients bec

关键词： Percutaneous endoscopic gastrostomy Car-bon dioxide insufflation pneumoperitoneum Abdomi-nal distension Randomized control study

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A rare etiology of post-endoscopic retrograde cholangiopancreatography pneumoperitoneum

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World Journal of Gastroenterology 2008年第18期14卷 2917-2919页

作者： Stelios F Assimakopoulos Konstantinos C Thomopoulos Sofia Giali Christos Triantos Dimitrios Siagris Charalambos Gogos Department of Internal Medicine School of Medicine University of Patras Patras 26110 Greece Division of Gastroenterology Department of Internal Medicine School of Medicine University of Patras Patras 26110 Greece

Major complications of endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, hemorrhage, cholangitis, and duodenal perforation. The occurrence of free air in the peritoneal cavity post- ERCP is a rare event (pneumoperitoneum, in an 84-year-old woman with pancreatic cancer and a large hepatic metastasis, after ERCP with common bile duct stent deployment. Our patient developed, pneumoperitoneum due to air leakage from rupture of intrahepatic bile ducts and Glisson’s capsule in the area of a peripheral large hepatic metastasis. The potential mechanism underlying this complication might be post- ERCP pneumobilia and increased pressure of intrahepatic bile ducts leading to rupture of intrahepatic bile ducts in the liver metastatic mass owing to neoplastic tissue friability. This case indicates the need for close clinical and radiological observation of patients with hepatic masses (primary or metastatic) subjected to ERCP. In such patients, avoidance of excessive air insufflation during ERCP and/or placement of a nasogastric tube for bowel decompression immediately after ERCP might be a reasonable strategy to prevent such unusual complications.

关键词： Endoscopic retrograde cholangiopancreatx ography pneumoperitoneum Complications Pneumobilia Hepatic metastases

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Low-pressure pneumoperitoneum with abdominal wall lift in laparoscopic total mesorectal excision for rectal cancer:initial experience

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World Journal of Gastroenterology 2018年第11期24卷 1278-1284页

作者： Ping-Tian Xia Maimaiti Yusofu Hai-Feng Han Chun-Xiao Hu San-Yuan Hu Wen-Bin Yu Shao-Zhuang Liu Department of General Surgery Qilu Hospital of Shandong University

AIM To evaluate the safety and feasibility of a new technology combining low-pressure pneumoperitoneum(LPP) and abdominal wall lift(AWL) in laparoscopic total mesorectal excision(TME) for rectal *** From November 2015 to July 2017,26 patients underwent laparoscopic TME for rectal cancer using LPP(6-8 mm Hg) with subcutaneous AWL in Qilu Hospital of Shandong University,Jinan,*** data regarding patients' demographics,intraoperative monitoring indices,operation-related indices andpathological outcomes were prospectively *** Laparoscopic TME was performed in 26 cases(14 anterior resection and 12 abdominoperineal resection) successfully,without conversion to open or laparoscopic surgery with standard-pressure *** monitoring showed stable heart rate,blood pressure and paw airway *** mean operative time was 194.29 ± 41.27 min(range:125-270 min) and 200.41 ± 20.56 min(range:170-230 min) for anterior resection and abdominoperineal resection,*** mean number of lymph nodes harvested was 16.71 ± 5.06(range:7-27).There was no positive circumferential or distal resection *** local recurrence was observed during a median follow-up period of 11.96 ± 5.55 mo(range:5-23 mo).CONCLUSION LPP combined with AWL is safe and feasible for laparoscopic *** technique can provide satisfactory exposure of the operative field and stable operative monitoring indices.

关键词： Laparoscopic surgery Abdominal wall lift Low-pressure pneumoperitoneum Rectal cancer Total mesorectal excision

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Jejunal diverticulosis found in a patient with long-standing pneumoperitoneum and pseudo-obstruction on imaging:a case report

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Gastroenterology Report 2016年第4期4卷 337-340,I0003页

作者： Carolyn Hanna John Mullinax Mark S Friedman Julian Sanchez USF Morsani College of Medicine TampaFLUSA Department of Surgical Oncology Moffitt Cancer CenterTampaFLUSA

Small bowel diverticulosis is a rare finding within the general population and jejunal diverticulosis,specifically,is even *** manifestations can range from post-prandial pain,constipation and malabsorption to serious complications,such as gastro-intestinal hemorrhage,perforation and acute intestinal *** we describe the case of an 81-yearold gentleman who presented with a three-year history of abdominal pain and weight *** unremarkable physical examination and laboratory tests,persistent pneumoperitoneum and dilated loops of small bowel were found on *** been given a diagnosis of small bowel bacterial overgrowth,the patient underwent capsule endoscopy study for further evaluation of his small *** capsule did not reach the colon and the patient never noted passing the capsule in his stool so,six months post-procedure,a computed tomography(CT)scan seemed to reveal the retained *** exploratory laparotomy revealed 200 cm of atonic,dilated jejunum with impressive diverticula along the antimesenteric *** case report is an example of an unusual set of presenting signs and symptoms of jejunal diverticulosis,including persistent pneumoperitoneum,pseudo-obstruction and small bowel bacterial overgrowth.A literature review has revealed that these signs have been present in other cases of jejunal diverticulosis,although the etiology and pathophysiology is not clearly understood.

关键词： Jejunal diverticulosis pneumoperitoneum pseudo-obstruction

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Study on incisional implantation of tumor cells by carbon dioxide pneumoperitoneum in gastric cancer of a murine model

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World Journal of Gastroenterology 1999年第6期5卷 544-546页

作者： Wang H Zheng MH Zhang HB Zhu J He JR Lu AG Ji YB Zhang MJ Jiang Y Yu BM Li HW Shanghai Second Med Univ Ruijin Hosp Dept Surg Shanghai 200025 Peoples R China Shanghai Inst Digest Surg Shanghai 200025 Peoples R China

INTRODUCTIONPort-site recurrence after laparoscopic tumor surgery is a frequent complication in cancer operations, such as gallbladder, stomach, ovary and colon[1-5]. The incidence of port-site recurrence after laparoscopic colectomy ranged from 1.1% to 6.3%, in contrast to a 0.68% tumor wound recurrence rate in patients undergoing curative open colectomy[6-8]. The possible mechanisms proposed were: ① contaminated laparoscopic instruments passing in and out of the port frequently; ② increased exfoliated cancer cells from laparoscopic manipulation; ③ adhered tumor cells by pneumoperitoneum[9-12]. Some experiments reported that desufflation related to seeding of port wounds via a stable suspension of tumor cells in CO2 gas was an unlikely cause of port tumors, some supported a direct intraperitoneal seeding of exfoliated tumor cells as its etiology and the instruments passing in and out of the port may play an important role in local recurrence[13-15]. The colon tumor cells were more common since laparoscopic colectomy was wildly performed.

关键词： stomach neoplasms colonic neoplasms cell movement carbon dioxide pneumoperitoneum murine model

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Massive Idiopathic pneumoperitoneum in Children: A Case Report

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Open Journal of Pediatrics 2018年第3期8卷 249-254页

作者： Sourou Bruno Noukpozounkou Yacoubou Imorou Souaibou Amoussou Sedjro Clotaire Romeo Houegban Houenoukpo Koco Orion Akokpe Michel Armand Fiogbe University Clinic of Pediatric Surgery National University Hospital Center “Hubert Koutoukou Maga” Cotonou Benin University Clinic of Visceral Surgery “A” National University Hospital Center “Hubert Koutoukou Maga” Cotonou Benin

The pneumoperitoneum is the abnormal presence of free air in the peritoneal cavity. In most cases it is related to the perforation of hollow organs. Nevertheless there are cases of pneumoperitoneum without obvious causes called idiopathic. We report a case of massive pneumoperitoneum of radiological discovery in a patient of 16 years old boy, sickle-cell of type SS, during the exploration of an angiocholitis. It was medically treated successfully. No obvious etiology had been found. This particular situation is a dogma which runs up against the classic interventionist spirit;therefore each of pneumoperitoneum needs to be studied case by case. The presence of signs of peritoneal irritation allows surgical exploration. Otherwise, laparoscopy seems to be a minimally invasive surgical method and allows a visual diagnosis by eliminating a hollow organ perforation.

关键词： pneumoperitoneum Spontaneous Idiopathic Laparoscopy

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Effects of carbon dioxide pneumoperitoneum on metastasis of ovarian carcinoma cell line SKOV_3

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Journal of Chongqing University 2007年第1期6卷 8-13页

作者：唐均英 HUANG Jin YAO Zhen-wei Department of Obstetrics and Gynecology the First Affiliated Hospital of Chongqing University of Medical Sciences Chongqing 400016P.R. China

The long suspicion of the potential harm of carbon dioxide （CO2） pneumoperitoneum exists in laparoscopic cancer surgery. For better understanding of this problem, we targeted this study at the effects of CO2 pneumoperitoneum on the invasive ability of ovarian carcinoma cell line and the possible mechanism within it. To study the effects of CO2 pneumoperitoneum on carcinoma cell, SKOV3 cells were divided into 2 groups, respectively exposed to pneumoperitoneal CO2-insuffiation and normal conditions. To study the possible mechanism, SKOV3 cells were divided into 3 groups, one was exposed to CO2 pneumoperitoneum, one to N2 and the other to normal conditions served as control. The in vitro adhesive and invasive ability of the cells was analyzed through 3-（4,5-dimethylthiazol-2-yl）-2,5-diphenyl tetrazolium bromide （MTT） assay and Boyden filters metastasis model; the expressions of vascular endothelial growth factor C （VEGF-C） and matrix metalloproteinase 9 （MMP9） were determined by reverse transcription polymerase chain reaction（RT-PCR）, and Western blot. We found that the adhesive ratio of SKOV3 cells exposed to CO2 was significantly higher than that of the control group; cells exposed to CO2 invaded the matrigel with a greater number （P〈0.01）; the expression of VEGF-C exposed to both CO2 and N2 was significantly increased compared with control group （P〈0.05）; the MMP9 expression level of CO2 group was higher than that of N2 group, P〈0.05. We concluded that carbon dioxide pneumoperitoneum may improve the adhesive and invasive ability of ovarian carcinoma cell line in vitro and CO2 can also be an independent factor to stimulate the expression of MMP9.

关键词： carbon dioxide pneumoperitoneum ovarian carcinoma matrix metalloproteinase 9 (MMP9) vascular endothelial growth factor C (VEGF-C)

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Uncommon cause of pneumoperitoneum

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World Journal of Gastrointestinal Surgery 2013年第12期5卷 329-331页

作者： Laura van Nunspeet Eric Hans Eddes Mirre E de Noo Department of Surgery Deventer Ziekenhuis

Free intraperitoneal air is thought to be pathognomonic for perforation of a hollow viscus. Here, we present a patient with pain in the upper left quadrant, a mild fever and leukocytosis. Free air was suggested under the left diaphragm but during the explorative laparotomy no signs of gastric or diverticular perforation were seen. Further exploration and revision of the computed tomography revealed a perforated splenic abscess. Splenic abscesses are a rare clinical entity. Presenting symptoms are often non-specific and include upper abdominal pain, recurrent or persistent fever, nausea and vomiting, splenomegaly, leukocytosis and left lower chest abnormalities. Predisposing conditions can be very divergent and include depressed immunosuppressed state, metastatic or contiguous infection, splenic infarction and trauma. Splenic abscess should therefore be considered in a patient with fever, left upper abdominal pain and leukocytosis. Moreover, our case shows that splenic abscess can present in an exceptional way without clear underlying aetiology and should even be considered in the presence of free abdominal air.

关键词： Spleen Abscess pneumoperitoneum

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Idiopathic neonatal pneumoperitoneum with favorable outcome: A case report and review

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World Journal of Gastroenterology 2015年第20期21卷 6417-6421页

作者： Tao-Zhen He Chang Xu Yi Ji Xiao-Yan Sun Min Liu Department of Pediatric Surgery West China Hospital of Sichuan University Health Management Centre West China Hospital of Sichuan University

Neonatal pneumoperitoneum is a surgical emergency indicative of gastrointestinal perforation that requires immediate treatment to prevent death. There have been non-surgical conditions secondary to neonatal pneumoperitoneum(e.g., mechanical ventilation, pulmonary diseases and pneumatosis cystoides intestinalis) that neonates were able to overcome without the need for abdominal exploration. Idiopathic pneumoperitoneum, although similar to perforation of the alimentary tract and the previously mentioned non-surgical conditions, is a more rare and benign condition that does not yet have a definite cause. Hence, inexperienced surgeons may have a difficult time providing the right treatment for idiopathic pneumoperitoneum. We report a case of a neonate with a massive pneumoperitoneum who obtained a favorable outcome without surgical intervention. Nonetheless, the cause of pneumoperitoneum remains unclear. We hypothesize that the right sized perforation(range: 2 mm to 4 mm in diameter) at the anterior wall of the stomach is needed for pneumoperitoneum to occur. As the baby cries(aerophagia), the air in the stomach accumulates until it can enter the intraperitoneal cavity through the leak compressed by gastric peristalsis, hence forming a large pneumoperitoneum. Small amounts of gastric juice are able to penetrate the gastric wall; therefore, no signs or symptoms of peritonitis occur. The gastric leak self-seals, preventing further passage of the air, allowing the intraperitoneal free gas to dissipate gradually. This case demonstrated that laparotomy can be avoided in neonates with idiopathic pneumoperitoneum if a timely diagnosis is established.

关键词： Intestinal perforation pneumoperitoneum Newborn Therapeutics

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