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1、开腹及腹腔镜于•术对腹膜纤溶系统影响的临床研究作者：胡行前，赵翰林单位：南京医科大学临床医学系外科学教研纽.，南京210029；无锡市第一人民医院微创外科，江苏无锡214001【摘要】目的探讨腹腔镜与开腹手术中腹膜纤维蛋白溶酚的变化。方法在腹腔镜与开腹手术前、后、立即，分别测最腹膜组织屮纽织型纤溶酶原激活物(IPA)、纤溶酶原激活物抑制物(PAI1)的浓度及tPA的活性。结果腹膜纽.织tPA浓度在腹腔镜手术和传统腹部手术两纽术中均下降，在传统腹部手术组下降更显著(P<0.05),而腹膜纽织PAI1水平在腹腔镜于•术纽•术前较高(P<
2、0.05),在传统腹部手术纽术中明显升高。手术后，两纽PAI1浓度无显著差异。tPA活性在两组术前、后均无明显差异，但术中两纽均显著下降(P<0.05)o结论腹腔镜和传统腹部于-术对腹膜的影响是相似的，腹腔镜于-术瑕初腹膜组织中PAI1浓度的升高是山于CO2气腹造成的，并影响腹膜组织的修复。【关键词】腹腔镜；纽织型纤溶酶原激活物；纤溶酶原激活物抑制物1:尿纤溶酶原激活物Effectofconventionalandlaparoscopicsurgeryonperitonealfibrinolyticcapacity：aprospectiv
3、erandomizedclinicaltrialHUXingqian,ZHAOHanlin1.DepartmentofSurgery,DepartmentofClinicalMedicine,NanjingMedicalUniversity,Nanjing210029,China;2.DepartmentofMicrosurgery,WuxiFirstPeople′sHospital,Wuxi21400LJiangsu,ChinaToinvestigatethefibrinolyticchangesinperitonealbiops
4、iesduringlaparoscopicandconventionalabdominalsurgeries.MethodsInlaparotomies,peritonealbiopsiesweretakenwhentheabdomenwasopenedandjustbeforebeingclosed・Inlaparoscopies,peritonealbiopsieswereopenedaftercarbondioxideinsufflationandwereclosedjustbeforeexsufflation.Concentration
5、softissuetypeplasminogenactivator(tPA),plasminogenactivatorinhibitortype1(PAI1)andtheresultingtPAactivityweredetermined・ResultsConcentrationsoftPAinperitonealtissuesdecreasedduringoperationsinbothgroups,butwasmoresignificantlyinthelaparotomygroup(P<0.05).PAI1levelsinopeni
6、ngbiopsieswerehigherinthelaparoscopygroupthanthatinthelaparotomygroup(P<0.05).PAI1concentrationswerealsoincreasedinlaparotomiesbutnotinlaparoscopies.Attheendoftheoperations,therewerenodifferencesbetweenthetwogroups.TheresultingtPAactivitydidnotdifferbetweenthetwogroupsato
7、peningorclosure,butitwasdecreasedinbothgroupsduringoperations(P<0.05).ConclusionThesefindingsindicatethattheperitonealresponsetoopenandlaparoscopicsurgeriesissimilar.TheinitialriseinperitonealPAI1concentrationduringlaparoscopiessuggestsadverseeffectsofcarbondioxideinsuffl
8、ation,whichmightaffectperitonealrepair.腹腔粘连的严重程度与手术创伤有关，山于外科手术导致腹腔粘连形成过程中，纤
