小儿腹腔镜监视下经皮腹膜外内环结扎术后有时会出现线结反应。本研究旨在探索腹壁不同层次打结诱导的迟发型超敏反应相关性蛋白的表达水平情况。

Balb/C小鼠随机分组，在同一小鼠腹壁自左向右分别纵向剪开3个皮肤切口（0.5 cm长），分别经切口处用无菌平镊提起全腹壁，采用4-0带针慕斯线进针贯穿腹壁至壁层腹膜内，经切口直视下经原针孔采用钩针将带针丝线折返钩出，经原线道出针，分别打结于皮下、肌层内和腹膜外间隙。术后14 d取材打结部位腹壁标本，连续冰冻切片进行组织化学和凋亡染色观察与分析。

免疫组织化学和半定量检测显示皮下组线结周围γ-干扰素和淋巴毒素-β的表达最为明显，腹膜外线结组最轻微，半定量检测分析显示差异有统计学意义。TUNEL检测可见腹膜外线结周围凋亡细胞最少，半定量检测分析显示差异有统计学意义。

线结位于深层腹膜外间隙引起超敏反应轻微，皮下浅层线结引起超敏反应最明显。提示对于腹腔镜监视下经皮腹膜外内环结扎术，将线结打在腹膜外间隙有利于降低线结诱导的超敏反应和超敏反应相关并发症的发生率。

A silk knot-induced inflammatory response can be seen in percutaneous extracorporeal knotting for laparoscopic inguinal inner ring closure in children. The present study aimed to explore the expression of delayed hypersensitivity-related proteins induced by knotting at different levels of the abdominal wall.

Balb/C mice randomized, in the same mouse abdominal wall from left to right, respectively longitudinal cut three skin incision (0.5 cm long), respectively through the incision of sterile flat forceps, using a 4-0 needle mousse line needle through the abdominal wall to the peritoneum, through the original needle hole, and knot in the subcutaneous, muscle, and extraperitoneal spaces. The abdominal wall specimens of the knotted site were taken 14 days after surgery, and serial frozen sections were subjected to histochemistry and apoptotic staining for observation and analysis.

Immunohistochemistry and semi-quantitative testing showed the most obvious expression of IFN-γ and Lymphotoxin β around the subcutaneous junction, and the slightest peritoneal peripheral junction, and semi-quantitative analysis showed significant statistical differences. TUNEL showed the least apoptotic cells around the peritoneal junction, and semi-quantitative analysis showed significant statistical differences.

The knot in the deep extraperitoneal space caused mild hypersensitivity, while the superficial subcutaneous knot caused the most obvious hypersensitivity. It suggests that for the ligation of a percutaneous intra-peritoneal endural loop under laparoscopic surveillance, beating the thread in the extraperitoneal space is beneficial to reduce the incidence of knot-induced hypersensitivity and hypersensitivity-related complications.