Sıçanlarda standart veya ısıtılmış-nemlendirilmiş CO2 insüflasyonları ile oluşturulan yüksek ve düşük basınçlı pnemoperitonyum modellerinde dokularda oluşan histopatolojik ve biyokimyasal değişikliklerin incelenmesi
Proje no. 20808 · Durum: Kapanmış · 2019
Özet
Aim: In laparoscopic surgery, it has been reported that standard carbon dioxide (CO2) gas may cause local and systemic inflammatory response, structural and morphological changes in tissues, and its use at body temperature and moist is recommended to reduce these effects. However, there are studies stating that the insufflation pressures used are more important than the structure of CO2 in the changes that occur. In this project, histopathological and biochemical changes were investigated by using CO2 at different temperatures and humidity at different pressures. Materials and Methods: Eighty non-pregnant female rats of 10-12 weeks of age, Wistar albino species, weighing an average of 325 grams (300-350 gr) were randomly divided into 10 groups. In rats except the control and sham groups, pneumoperitoneum was formed with low (4 mmHg) and high pressure (8mmHg) and heated-humidified CO2 with standard CO2 was used. Some of these rats underwent laparotomy at the 12th hour after 60 minutes of pneumoperitoneum, the other group at the 12th hour after 30 minutes of reperfusion, tissue, blood and plasma samples were taken. These samples taken by histopathological and biochemical methods were evaluated. Results: In this study, samples taken from 68 rats were found suitable for statistical evaluation. As a result of H&E staining macroscopically, degenerative changes due to granulosa cells and edema were observed in the ovary, secondary and tertiary follicles in the high-pressure standard CO2 group. Vascular congestion and hemorrhage were remarkable in all of the patients who were applied high pressure in the heated-humid group, and only in the reperfusion group among those who were applied low pressure. Inflammatory cell infiltration was significant in all reperfusion groups except for low pressure moist-heated CO2, and vacuolization in the corpus luteum structure in all reperfusion groups with high pressure. In the peritoneum tissue, thickening in the submesothelial region, different degrees of cellular separation, and a significant increase in the number of submesothelial fibroblast cells were observed in all high-pressure groups, especially in the high-pressure standard CO2 group. When all pressure and CO2 structure ischemia groups were compared, all histopathological evaluations were significant in the standard CO2 group except for the peritoneal apoptotic index at low pressure, and the ovarian and peritoneum INOS at high pressure. Among the ischemia-reperfusion groups, the standard CO2 group was significant compared to the heated-humid group in all pressure groups except the ovarian apoptotic index at low pressure and peritoneal PCNA. When the ischemia and ischemia-reperfusion groups were compared, standard CO2 group was found to be significant except for peritoneal PCNA in both low- and high-pressure groups, while peritoneal PCNA was not significant in only the low-pressure group. The heated-humid CO2 group did not cause significant changes in the ovary and peritoneum at low pressure histopathologically, but only the ovarian and peritoneal apoptotic index and ovarian INOS were found to be significant at high pressure. In biochemical evaluations, only TNF-? and AMH were found to be significant in plasma at low pressure among the ischemia groups, while the standard CO2 group was more in terms of low-pressure IL-6, TNF-? and 8-OHdG, and high-pressure TNF-? and 8-OHdG among the ischemia-reperfusion groups. found high. In the tissue, IL-6 and TNF-? were found to be significantly higher in the standard CO2 group where only high pressure was applied and both high and low pressure was applied in plasma between ischemia and ischemia-reperfusion groups. In the heated-humid group, only IL-6 was significant at high pressure. In terms of AMH, there was no significant difference in plasma, except for the low pressure heated-humid group. Again, only in plasma measurements, 8-OHdG was significant in all CO2 groups at both low and high pressure. Conclusion: It was seen that standard CO2 caused histopathological changes and systemic inflammation more clearly at high pressures and also at low pressures. Although these changes in the heated-humid group were less than standard CO2 at high pressure, they still occurred. The best results were obtained in the low pressure heated-humid CO2 group. However, it was observed that follicle reserves were not affected much during short laparoscopy.