Karbondioksit ile Oluşturulan Pnömoperitoneumun Periton Yapısı Üzerine Etkileri

Öz

Giriş :  Laparoskopik ameliyatların uygulanmaya başlamasıyla beraber pnömoperiton oluşturmak için birçok gaz denenmiştir.  Bunlar arasında halen  en yaygın kullanımda olan karbondioksit gazıdır.  karbondioksit ile oluşturulan pnömoperiton  laparoskopik ameliyatlarda cerrahlara uygun alan oluşturmasına rağmen   peritoneal yapı üzerinde birtakım istenmeyen  değişikliklere de sebep olmaktadır. Bu yan etkilerden bazıları kaçınılmaz olmasına rağmen bazı yan etkilerde uygulama şekline bağlı değişiklik gösterebilmektedir .

Metod:  Karbondioksit ile oluşturulan pnömoperitonun peritoneal yapı üzerine etkilerine ilişkin  literatürdeki yapılan deneysel ve klinik çalışmalar dikkate alınarak bu derleme hazırlandı.

Sonuçlar : Pnomöperiton oluşumu peritoneal çevreyi ve dolayısıyla organizmayı etkiler. Bu etkilenim intraabdominal basınç artışı, karbondioksitin lokal peritoneal destrüktif etkileri, karbondioksit emilimi ve kimyasal metabolik  değişimler gibi sebeplerle olmaktadır.  İnsuflasyon hızı ve basıncı genel olarak hemodinamik değişiklikler yapmaktadır. Karbondioksitin hipoksiketkisi,  toksik  etkisi, kuruluğu,soğukluğu peritoneal çevrenin yapısal bozulmasına sebep olmaktadır.

Tartışma : laparoskopik cerrahi hergeçen gün daha da yaygınlaşmaktadır. Bu ndenle özellikle ek hastalığı olan ya da obez hastalarda pnömoperitonun yaptığı etkiler hakkında farkındalığa sahip olunması önemlidir. Bu farkındalık hastaların pnömoperitonun yaptığı istenmeyen değişikliklerden etkilenimini azaltacağı kanısındayız.

Anahtar Kelimeler

• karbondioksit pnömoperitoneum,laparoskopi,karbondioksit insuflasyon

The Effects of Carbon Dioxide Pneumoperitoneum on Peritoneal Structure

Öz

Background:  To create pneumoperitoneum at the beginning of laparoscopic surgery, several gases have been trialled. The most commonly used of these gases is carbon dioxide. Although pneumoperitoneum created with carbon dioxide provides an appropriate area for surgeons to perform laparoscopic operations, it can also cause several unwanted changes to the peritoneal structure. Some of these side-effects are inevitable but some exhibit changes depending on the method of application.

Methods:  This review was prepared taking into consideration the previous experimental and clinical studies in literature related to the effects on the peritoneal structure of pneumoperitoneum created with carbon dioxide.

Results: The creation of pneumoperitoneum affects the peritoneal environment and thereby the organism. This effect is caused by increased intra-abdominal pressure, the local peritoneal destructive effect, carbon dioxide absorption and chemical metabolic changes. The insufflation rate and pressure generally make haemodynamic changes. The hypoxic effect of carbon dioxide, the toxic effect, the dryness and the coldness may cause structural impairment of the peritoneal environment.

Conclusions: Laparoscopic surgery is becoming more widespread. Therefore, it is important to be aware of the effects created by pneumoperitoneum, especially in obese patients or those with concomitant diseases. With this awareness, it will be possible to reduce the effects of the undesired changes wrought by pneumoperitoneum. 

Anahtar Kelimeler

• Carbon dioxide pneumoperitoneum,laparoscopy,,carbon dioxide insufflation

Kaynakça

1. 1. Nagy JA, Jackman RW. Anatomy and physiology of the peritoneal membrane.Semin Dial 1998;11:49-56
2. 2. Slater N J, Raftery A T, Cope G H. The ultrastructure of human abdominal mesothelium. J.Anat 1989;167:47-56
3. 3. Michailova K, Wassilev W, Wedel T. Scanning and transmission electron microscopic study of visceral and parietal peritoneal regions in the rat. Ann Anat. 1999;181:253–260.
4. 4. Suematsu T, Hirabayashi Y, Shiraishi N, Adachi Y, Kitamura H, Kitano S. Morphology of the murine peritoneum after pneumoperitoneum vs. laparotomy. Surg Endosc. 2001;15:954–958.
5. 5. Liu Y, Hou QX. Effect of carbon dioxide pneumoperitoneum during laparoscopic surgery on morphology of peritoneum. Zhonghua Yi Xue Za Zhi. 2006;86:164–166
6. 6. Brokelman WJ1, Lensvelt M, Borel Rinkes IH, Peritoneal changes due to laparoscopic surgery. Surg Endosc. 2011 Jan;25(1):1-9
7. 7. Levy BS, et al. Air embolism during gynaecologic endoscopic surgery.J Am Assoc Gynecol laparosc. 1997;4;291-292
8. 8. Saad RS, et al.Fatal air embolism:a complication of manupilation of a cavitatingmetastatic lesion of the liver.Eur J Anaesthesiol.1998;15:372-375

9. 9. Wildbrett P, Oh A, Noundorf D. Et al. İmpact of laparoscopic gases on peritoneal microenvirement and essential parameters of cell function. Surg Endosc 2003;17:78-82
10. 10. Ikechebelu J.I. et al. Coprasion of carbon dioxide and room air pneumoperitoneum for day-case diagnostic laparoscopy. J. of Obst and Gynaecol. 2005;25(2):172-173
11. 11. Perili V. Et al . carbon dioxide elimination patern in morbidly obese patients undergoing laparoscopic surgery. Surg for Obesity and related disease.2012;8:590-594
12. 12. Nasajyan N. et al. Coparisonn of loww and standart pressure gas injection at abdominal cavity on postoperative nausea and vomiting in laparoscopic cholecystectomy. Pak J Med. 2014;30(5):1083-1087
13. 13. Lee Js et al. A simple method of reducing residual intraperitoneal carbon dioxide after laparoscopic cholecystectomy : a prospective, ramdomized, controlled study. J ,laparoendosc Adv Surg Tech A.2014;24(8):563-6
14. 14. Volz J et al. characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum. Surg Endosc.1999;13:611-614
15. 15. Marcos T A et al. Does CO2 Pneumoperitoneum ALter the Ultra-Structure of the Mesotelium?. Journal of Surgical Research. 2006;133:84-88
16. 16. Liu Y, Hou QX. Effects of carbon dioxide pneumoperitoneum during laparoscopic surgery on morphology of peritoneum. Zhonghua Yi Xeu Za Zhi. 2006;86(3):164-6.
17. 17. Beyhan K et al. does carbon dioxide pneumoperitoneum altering pressure levels lead to ultrastructural damage of fallopian tuba and ovary?. Clin Exp Obstet Gynecol. 2013;40(4):551-6
18. 18. Paparella A et al. Peritoneal morphological changes due to pneumoperitoneum: the effect of intra-abdominal pressure. Eur J Pediatr Surg.2014;24(4):322-7
19. 19. Yeşildağlar N, Koninckx P.R. Adhesion formation in intubed rabbits increases with high insufflation pressure during endoscopic surgery. Human Reproduction. 2000 Vol.15 no:3 pp687-691
20. 20. Molinas C. R et al. peritoneal mesothelial hypoxia during pneumoperitoneum is a co-factor in adhesion formation in a laparoscopic Mouse model. Fertil Steril.2001;76:560-567
21. 21. Molinas C. R. And Koninckx P R. Hipoxemia induced by CO2 or helium pneumoperitoneum is a co-factor in adhesion formation in rabbits. Human Reproduction. 2000 Vol.15 no:8 pp1758-1763
22. 22. Torres K. et al. Does thermodynamic stability of peritoneal collagen change during laparoscopic cholecystectomies? A differantial scanning calorimetry (DSC) study. Surg Endosc. 2014;28:2623-2626
23. 23. Hazebroek E.J et al. Impact of temperature and Humidity of carbon dioxide pneumoperitoneum on body temperature and peritoneal morphology. Journal Laparoendoscopic and Advanced Surgical Teq.2002 vol2 no.5
24. 24. Klugsberger B. Et al. Warmed, humidified carbon dioxide insufflation versus standard carbon dioxide in laparoscopic cholecystectomy: a double-blinded randomized controlled trial. Surg Endosc. 2014;28:2656-2660
25. 25. Peng Y. Et al. Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations. Journal of Surgical Research 2009;151:40-47.
26. 26. Umar A.et al. Evaluation of hemodynamic changes using different intra-abdominal pressures for laparoscopic cholecystectomy. Indian J Surg. 2013;75(4):284-9.
27. 27. Lou HX. et al. Effects of CO(2) pneumoperitoneum on peritoneal macrophage function and peritoneal metastasis in mice with gastric cancer. Eur Surg Res. 2012;48(1):40-7
28. 28. Tarhan O.R. et al. Structural deteriorations of the human peritoneum during laparoscopic cholecystectomy. A transmission electron microscopic study. Surg Endosc. 2013 Aug;27(8):2744-50