With the extensive application of laparoscopy in clinical surgery, the advantages of laparoscopic surgery such as less intraoperative bleeding, small and beautiful incision, and rapid postoperative recovery become increasingly prominent. However, prolonged use of carbon dioxide (CO2) pneumoperitoneum or high CO2 pneumoperitoneum pressure during laparoscopic surgery may cause subcutaneous emphysema and hypercapnia, in severe cases which may affect the quality of recovery and prognosis of patients. The use of a protective ventilation strategy during laparoscopic surgery under general anesthesia, a mechanical ventilation model of controlled hyperventilation, can reduce or avoid the effects of hypercapnia caused by prolonged CO2 pneumoperitoneum or high CO2 pneumoperitoneum pressure. This article reviews the effects of laparoscopic CO2 pneumoperitoneum on patients, the application of controlled hyperventilation in laparoscopic surgery under general anesthesia and the effects of controlled hyperventilation on patients. The aim is to provide a theoretical basis for the safe and effective application of controlled hyperventilation in laparoscopic surgery.
Objective To explore the effects of intraperitoneal chemotherapy with fluorouracil (FU) on the growth and metastasis of tumor cells in carbon dioxide (CO2) pneumoperitoneum. Methods Fifty male H-22 mice of clean grade were selected and randomly assigned into 5 groups in each group with 10: simple implantation group, pneumoperitoneum group, pneumoperitoneum and NS group, pneumoperitoneum and low concentration (5.0 g/L) of FU group and pneumoperitoneum and high concentration (10.0 g/L) of FU group. All mice were executed after 11 days to observe the weight and the implantation of tumor in abdominal wall. Then the expressions of proliferating cell nuclear antigen (PCNA) and vascular endothelial growth factor (VEGF) were detected by immunohistochemistry. Results The tumor weight was significantly higher in pneumoperitoneum and high concentration of FU group compared with other groups except pneumoperitoneum and low concentration of FU group (P＜0.05, P＜0.01 ). The inhibition rate of tumor was 64.5% in pneumoperitoneum and high concentration of FU group. The diameter of portsite implantation nodus was significantly bigger in pneumoperitoneum and NS group compared with pneumoperitoneum and low concentration of FU group and pneumoperitoneum and high concentration of FU group (P＜0.01). The expressions of PCNA and VEGF of ascites and portsite implantation nodus were significantly different in every group, respectively (P＜0.05, P＜0.01). Conclusion There is inhibitive effect of intraperitoneal chemotherapy with high concentration of FU on the growth and metastasis of S-180 tumor cells in CO2 pneumoperitoneum, which may be associated with downregulation of PCNA and VEGF expressions.
