悬吊式非气腹与气腹经脐单一部位切口腹腔镜胆囊切除术的临床对比研究

发布时间：2018-08-07 14:33

【摘要】：目的探讨悬吊式非气腹经脐单一部位腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床应用价值。方法回顾性分析2012年5月~2013年5月气腹经脐单一部位LC 32例(气腹组)和悬吊式非气腹经脐单一部位LC 32例(非气腹组)的临床资料,比较2组患者术中平均动脉压(MAP)、气道峰值压力(PIP)、脉搏、血氧饱和度(Sp O2)、中心静脉压(CVP)和血气分析,手术时间,术中出血量,术后肛门排气时间,术后不适等并发症。结果 T1时点(麻醉后开始LC时)2组MAP、CVP、Sp O2均无统计学差异(P值均0.05);气腹组PIP(24.7±4.1)cm H2O,明显高于非气腹组(15.7±2.9)cm H2O(t=-10.138,P=0.000)。T2时点(完成LC时)2组Sp O2无统计学差异(P0.05);气腹组PIP(25.1±4.9)cm H2O,明显高于非气腹组(16.6±1.8)cm H2O(t=-9.211,P=0.000);气腹组Pa CO2(57.2±3.5)mm Hg,显著高于非气腹组(37.5±3.4)mm Hg(t=-22.838,P=0.000)。2组患者术中出血量、手术时间均无统计学差异(P0.005);非气腹组术后肠道功能恢复(肛门排气)时间显著早于气腹组(t=-7.637,P=0.000),术后腹胀、恶心呕吐和肩背部疼痛的发生率显著低于气腹组(χ2=6.488,P=0.011;χ2=5.317,P=0.021)。结论改良悬吊式非气腹经脐单一部位LC对老年患者的呼吸、循环功能影响更小,术后恢复更快,并发症更少,手术安全性提高,值得推广。
[Abstract]:Objective to evaluate the clinical value of laparoscopic cholecystectomy (LC) with suspension type non pneumoperitoneum via single site laparoscopic cholecystectomy (LC). Methods the clinical data of 32 cases (pneumoperitoneum) and LC 32 cases (non pneumoperitoneum) in the single site of pneumoperitoneum via pneumoperitoneum in May 2012 and May were analyzed retrospectively. The clinical data were compared 2. The average arterial pressure (MAP), peak pressure of airway pressure (PIP), pulse, blood oxygen saturation (Sp O2), central venous pressure (CVP) and blood gas analysis, operation time, intraoperative bleeding, postoperative anus exhaust time, postoperative discomfort and other complications. Results there were no statistical differences between 2 groups of MAP, CVP and Sp O2 (P value was 0.05) at T1 point (after anesthesia began LC); PIP (24.7 + 4.1) cm H2O in abdominal group was significantly higher than that in non pneumoperitoneum (15.7 + 2.9) cm H2O (t=-10.138, P=0.000).T2 time point (when LC) 2 groups of Sp O2 had no statistical difference (25.1 + 4.9), obviously higher than non pneumoperitoneum (16.6 + 1.8), and pneumoperitoneum (57.2 + 3.5), significantly higher than non pneumoperitoneum (37.5 + 3.) 4) there was no significant difference in the amount of bleeding during the operation of the mm Hg (t=-22.838, P=0.000) group and the operation time (P0.005). The time of postoperative intestinal function recovery (anal exhaust) in the non pneumoperitoneum group was significantly earlier than that of the pneumoperitoneum (t=-7.637, P=0.000). The postoperative abdominal distention, nausea and vomiting and the pain in the back of the shoulder were significantly lower than those in the pneumoperitoneum group (x 2=6.488, P=0.011; Chi 2=5.317, P=0). .021) conclusion the modified suspension type non pneumoperitoneum single site LC has less influence on the respiratory function of the elderly patients, the postoperative recovery is faster, the complications are less, and the safety of the operation is improved. It is worth popularizing.
【作者单位】：富阳市人民医院肝胆外科;
【基金】：2013年浙江省杭州市科技发展引导计划项目
【分类号】：R657.4

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