妇科腹腔镜手术对机体腹膜形态学的影响

Effect of gynecologic laparoscopic surgery on morphology of peritoneum

目的探讨妇科腹腔镜手术对机体腹膜形态学的影响。方法将40例子宫肌瘤或单纯卵巢囊肿患者(排除腹膜炎症患者)随机分别进行腹腔镜手术和开腹手术,于手术0、30、60、90及120min分别采集壁层腹膜,对其进行透射电镜(TEM)和扫描电镜(SEM)观察腹膜间皮细胞形态学变化。结果腹腔镜组充气后间皮细胞迅速肿胀,60min可见腹膜间皮细胞间连接断裂,基底膜裸露,120min更明显,而在开腹组间皮质细胞未见明显变化,90min细胞间连接偶可见断裂。结论妇科腹腔镜组与开腹组相比,改变了腹膜的形态学,而且与充气时间有关,可能有利于腹腔内恶性肿瘤的转移。

[Objective] To study the effect of gynecologic laparoscopic operation on morphology of peritoneum. [Methods] 40 patients with myoma of uterus or ovarian pupre cyst (excluding peritonitis patients) were randomized to operate by laparoscopic surgery (n=20) or laparotomy (n=20), the parietal peritoneum was resected from each patients in different time (0 min, 30 min, 60 min, 90 min,120 min) and examined by transmission electron microscopy (TEM) and scanning electron microscopy (SEM) for morphologic changes of the peritoneal mesothelial cells. [Results] Bulging up of mesothelial cells was evident immediately after pneumoperitoneum, starting 60 min after insufflation of the pneumoperitoneum, intercellular clefts were found and parts of the underlying basal lamina were laid bare, significantly after 120 min; whereas detachment and bulging up of the mesothelial cells were not found, intercellular clefts were occasionally found after 90 min. [Conclusions] Morphologic alterations of peritoneum after gynecologic laparoscopy differed from those after laparotomy and were influenced by duration of insufflation. These peritoneal changes after pneumoperitoneum may be associated with a specific intraperitoneal tumor spread after laparoscopic cancer surgery.