Preservation of peritoneal fibrinolysis owing to decreased transcription of plasminogen activator inhibitor-1 in peritoneal mesothelial cells suppresses postoperative adhesion formation in laparoscopic surgery

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• 作者：Manabu Shimomura ; MD ; Takao Hinoi ; MD ; ^{thinoi@hiroshima-u.ac.jp} ; Satoshi Ikeda ; MD ; Tomohiro Adachi ; MD ; Yasuo Kawaguchi ; MD ; Masakazu Tokunaga ; MD ; Tatsunari Sasada ; MD ; Hiroyuki Egi ; MD ; Kazuaki Tanabe ; MD ; Masazumi Okajima ; MD ; Hideki Ohdan ; MD
• 刊名：Surgery
• 出版年：2013
• 出版时间：March, 2013
• 年：2013
• 卷：153
• 期：3
• 页码：344-356
• 全文大小：723 K

文摘

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Background

Postoperative adhesion formation is regulated by peritoneal fibrinolysis, which is determined by tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1). This study compared peritoneal fibrinolysis and adhesion formation after laparoscopic surgery (LAP) and open surgery (OP).

Methods

We divided 154 male rats into 3 groups after cecal cauterization: Control, no treatment; LAP, CO₂ pneumoperitoneum at 5 mmHg for 60 minutes; and OP, laparotomy for 60 minutes. Adhesions were quantified at day 7. The activity and mRNA level of tPA and PAI-1 were determined by enzyme-linked immunosorbent assay in plasma and peritoneal lavage and by real-time polymerase chain reaction in peritoneal mesothelial cells from omentum. We also examined peritoneal fibrinolysis in human gastric cancer patients treated with LAP (n = 14) or OP (n = 10).

Results

In the animal study, adhesion scores, PAI-1 activity in peritoneal lavage fluid, and PAI-1 mRNA levels in peritoneal mesothelium were significantly greater in the OP group than the control and LAP groups. In the human study, postoperative PAI-1 mRNA levels were significantly greater in the OP group than the LAP group. Additionally, PAI-1 mRNA levels and subsequent adhesion formation were induced by prolonged operative time in the OP group, but not the LAP group.

Conclusion

Preservation of peritoneal fibrinolysis owing to decreased PAI-1 expression at the transcriptional level in peritoneal mesothelial cells is associated with suppression of postoperative adhesion formation in LAP. PAI-1 mRNA levels and subsequent adhesion formation were not induced by prolonged operative time in LAP. These results highlight the less invasiveness nature of LAP.