Objective To evaluate the effects of low pneumoperitoneum pressure under deep muscle relaxation on inflammatory factors, oxidative stress and morphology of distal greater omental capillary endothelial cells in patients undergoing laparoscopic radical gastrectomy (LAG) for gastric cancer.
Methods Sixty patients with LAG were selected from January to June 2022, 45 males and 15 females, aged 40-75 years, BMI 18-30 kg/m2, ASA physical status Ⅰ or Ⅱ. Patients were randomly divided into two groups: low pneumoperitoneum pressure group (group PL) and the control group (group PH), 30 patients in each group. Both groups were treated with deep muscle relaxation condition (PTC = 1 or 2), and the pneumoperitoneum pressure was set at 10 mmHg in group PL, and 14 mmHg in group PH. The duration of pneumoperitoneum maintenance, surgical time, anesthesia time, extubation time, PACU stay time, postoperative hospitalization time, the number of effective PCIA compressions and total PCIA compressions within 48 hours after surgery, and number of relief analgesia were recorded. The plasma concentrations of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), contents of malondialdehyde (MDA), superoxide dismutase (SOD), and reduced glutathione (GSH) were recorded 5 minutes before induction, 5 minutes before abdominal closure, and 24 hours after surgery. The morphology of capillary endothelial cells in the omental membrane was observed 5 minutes after opening abdomen and 5 minutes before abdominal closure.
Results Compared with group PH, the number of effective PCIA compressions and total PCIA compressions in group PL were significantly reduced within 48 hours after surgery (P < 0.05), the concentration of IL-6 was significantly decreased in group PL 5 minutes before abdominal closure and 24 hours after surgery (P < 0.05), the content of MDA was significantly decreased in group PL 5 minutes before abdominal closure (P < 0.05). The endothelial cell of the greater omental capillaries was slightly edematous and unevenly thick, while the nuclear contractile function was slightly weakened and the vascular lumen was moderately narrowed in group PL 5 minutes before abdominal closure. By contrast, the group PH showed obvious swelling of the endothelial cells with significant intracellular fluid accumulation and severe edema, while the vascular lumen turned to be extremely narrow and the nucleus became severe swelling.
Conclusion The use of deep muscle relaxation with low abdominal pressure at 10 mmHg in laparoscopic surgery for gastric cancer can diminish inflammation and oxidative stress, alleviating postoperative pain, reduce the pneumoperitoneum pressure-induced damage on capillary endothelial cells, and leading to better early postoperative recovery． |
