The effect of pneumoperitoneum on morphometric parameters of small-caliber diaphragmatic arteries: an experimental randomized controlled study
DOI:
https://doi.org/10.26641/1997-9665.2025.2.23-28Keywords:
experiment, rats, pneumoperitoneum, diaphragm, morphology, morphometry.Abstract
Background. During laparoscopy, systemic and pulmonary vascular resistance increase, central venous pressure is elevated, and peritoneal structures are subjected to ischemia-reperfusion injury. Understanding the patient's microvascular status is clinically important, as impaired microcirculation is associated with poorer perioperative outcome of elective major surgery. The objective of the work was to study the morphometric parameters of small-caliber diaphragmatic arteries under the influence of standard pressure pneumoperitoneum of different durations. Methods. 55 animals were divided into 4 groups, control and 3 experimental groups depending on the duration of pneumoperitoneum, 1, 3 and 5 hours, according to the group number. The costal and lumbar parts of the diaphragm were selected separately, followed by the study of morphometric indicators of small-caliber arteries, which were subjected to statistical processing. Results. During the study, an increase in the external diameter of the vessel and a decrease in the internal diameter were detected, which led to a decrease in the permeability of the arteries. These changes led to an increase in the Vogenworth index. The media thickness index increased statistically significantly. The height of endothelial cells in the I and II experimental groups decreased statistically insignificantly, except for the III experimental group where the Student criterion was less than 0.01. The diameter of the endothelial cell nuclei showed a decrease in the I and II groups, but was greater in the III experimental group (p < 0.05). The relative volume of damaged endothelial cells increased significantly (p < 0.001) with an increase in the duration of pneumoperitoneum, especially in the II and III experimental groups. Conclusion. Progressive reduction of the lumen of small-caliber vessels due to an increase in the outer diameter and a decrease in the inner diameter significantly worsens the blood supply to the costal and lumbar parts of the diaphragm, which indicates a deterioration in their physiological capacity under given conditions. The manifestations of endothelial dysfunction are deepened due to a decrease in the height of endothelial cells and a sharp increase in the relative volume of damaged endothelial cells.
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