腹腔镜术中腹内压与急性胃肠损伤的相关研究

发布时间：2018-08-12 14:57

【摘要】：目的急性胃肠损伤是指由于急性疾病本身导致的胃肠功能障碍。自从腹腔镜技术及“快通道外科”理念广泛应用于临床,结直肠切除术后急性胃肠损伤的发病率呈显著下降。但是腹内压升高至12~15mm Hg引起的腹腔内高压可能会导致急性胃肠损伤的发生,目前尚不清楚腹腔镜手术中腹内压升高与术后急性胃肠损伤之间的相关性。本研究旨在评估腹腔镜结直肠手术中CO_2气腹压力升高对术后急性胃肠损伤的影响。方法66例接受结直肠癌手术的患者随机平均分成3组,各组术中CO_2气腹压力分别设定为10mm Hg,12mm Hg和15mm Hg。术后记录患者首次排气/排便的时间、恢复肠蠕动的时间、进食半流质的时间、呕吐及腹泻的出现情况用来评估急性胃肠损伤的发生及程度。同时在建立CO_2气腹前及术后第一天测定患者血清内白介素-6和肿瘤坏死因子-α的水平。结果本研究共纳入41例男性和25例女性病例,平均年龄63.6岁,其中共15例(27.3%)出现急性胃肠损伤(除外11例符合退组标准)。CO_2气腹引起的腹内压增高并没有增加急性胃肠损伤的发生率(X_2=2.04,p0.05),也没有增加其严重程度(X_2=2.00,p0.05)。较低的腹内压力也没有加速胃肠功能的恢复并缩短住院时间(X_2=0.90,p0.05)。术后白介素-6水平升高但与术中腹内压力无关(X_2=2.65,p0.05)。结论腹腔镜结直肠手术后急性胃肠损伤的发生率与术中腹内压力升高无关,腹腔镜结直肠手术在腹腔内压力升高至15mm Hg以内安全可行。
[Abstract]:Objective Acute gastrointestinal injury refers to gastrointestinal dysfunction caused by acute disease itself. Since laparoscopic techniques and the concept of "fast-track surgery" have been widely used in clinical practice, the incidence of acute gastrointestinal injury after colorectal resection has decreased significantly. However, intraperitoneal hypertension caused by elevated intraabdominal pressure to 12-15 mm Hg may lead to acute gastrointestinal dysfunction. The relationship between elevated intra-abdominal pressure and postoperative acute gastrointestinal injury in laparoscopic colorectal surgery is unclear. The aim of this study was to evaluate the effect of elevated CO_2 pneumoperitoneal pressure on postoperative acute gastrointestinal injury in laparoscopic colorectal surgery. Intraoperative CO_2 pneumoperitoneal pressure was set at 10 mm Hg, 12 mm Hg and 15 mm Hg. The time of first exhaust/defecation, the time of recovery of intestinal peristalsis, the time of eating semifluid, the occurrence of vomiting and diarrhea were recorded after operation to assess the occurrence and severity of acute gastrointestinal injury. Results A total of 41 male and 25 female patients with an average age of 63.6 years were enrolled in this study. Among them, 15 (27.3%) suffered from acute gastrointestinal injury (except 11 who met the criteria for withdrawal). Increased intra-abdominal pressure caused by CO_2 pneumoperitoneum did not increase the incidence of acute gastrointestinal injury (X_2=2.04). The lower intra-abdominal pressure did not accelerate the recovery of gastrointestinal function and shorten the hospital stay (X_2 = 0.90, P 0.05). The elevated level of interleukin-6 was not associated with intra-operative intra-abdominal pressure (X_2 = 2.65, P 0.05). Conclusion The incidence of acute gastrointestinal injury after laparoscopic colorectal surgery was related to intra-operative pressure. It is safe and feasible for laparoscopic colorectal surgery to increase the intraperitoneal pressure to less than 15 mm Hg.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R656

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