[1]郭润生,闫金龙,谢津璧**①,等.低气腹压辅助悬吊式腹腔镜在老年胆囊切除术中的应用研究[J].中国微创外科杂志,2018,18(6):481-485.
　Guo Runsheng*,Yan Jinlong*,Xie Jinbi,et al.Laparoscopic Cholecystectomy With Low-pressure Abdominal Wall Lifting in Elderly Patients[J].Chinese Journal of Minimally Invasive Surgery,2018,18(6):481-485.
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低气腹压辅助悬吊式腹腔镜在老年胆囊切除术中的应用研究()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
18
期数:
2018年6期
页码:
481-485
栏目:
临床论著
出版日期:
2018-09-30

文章信息/Info

Title:
Laparoscopic Cholecystectomy With Low-pressure Abdominal Wall Lifting in Elderly Patients
作者:
郭润生; 闫金龙; 谢津璧**①; 陈跃宇; 史佩东
上海市嘉定区中心医院普外科，上海201800
Author(s):
Guo Runsheng*;  Yan Jinlong*;  Xie Jinbi;  et al.
*Department of General Surgery, Central Hospital of Jiading District, Shanghai 201800, China
关键词:
腹腔镜胆囊切除术; 老年患者; 低气腹压辅助悬吊腹腔镜手术
Keywords:
Laparoscopic cholecystectomy; Elderly patients; Low-pressure abdominal wall lifting laparoscopic surgery
文献标志码:
A
摘要:
目的探讨低气腹压辅助悬吊式腹腔镜在老年胆囊切除术中的应用价值。方法将2015年8月~2017年7月150例65岁及以上腹腔镜胆囊切除术随机分为气腹组（气腹压13~15 mm Hg）、无气腹组、低压悬吊1组（10~12 mm Hg）、低压悬吊2组（7~9 mm Hg）、低压悬吊3组（4~6 mm Hg），各组均为30例。监测气腹形成后5 min、20 min以及气腹放尽后5 min心率、收缩压、呼气末CO2分压、气道压力，记录手术时间，术前、术后2 h和8 h抽血检测D-乳酸、二胺氧化酶（DAO）。结果低压悬吊3组心率和收缩压变化较气腹组更小（P<0.05）。低压悬吊3组气道压力及呼气末CO2分压明显低于气腹组（P<0.05）。手术时间无气腹组显著长于气腹组和3个低压悬吊组（P<0.05），低压悬吊3组与气腹组之间无显著性差异（P>0.05）。D-乳酸、二胺氧化酶各组之间无显著差异（P>0.05）。结论与传统气腹腹腔镜手术相比，低气腹压（4~6 mm Hg）辅助悬吊式腹腔镜手术对循环和呼吸功能的影响更小；与无气腹悬吊式腹腔镜手术相比，低气腹压（4~6 mm Hg）辅助悬吊式腹腔镜手术可以缩短手术时间，减少术中出血量。低气腹压（4~6 mm Hg）辅助悬吊式腹腔镜手术值得在老年患者胆囊切除术中推广应用。
Abstract:
ObjectiveTo evaluate the value of laparoscopic cholecystectomy with low-pressure abdominal wall lifting in elderly patients.MethodsFrom August 2015 to July 2017, 150 patients over 65 years old underwent laparoscopic cholecystectomy. They were randomly divided into 5 groups: the pneumoperitoneum group (13-15 mm Hg,n=30), gasless abdominal wall lifting group (n=30), low-pressure abdominal wall lifting group 1 (10-12 mm Hg, n=30), low-pressure abdominal wall lifting group 2 (7-9 mm Hg, n=30), low-pressure abdominal wall lifting group 3 (4-6 mm Hg, n=30). The heart rate, systolic pressure, PETCO2, operation duration, airway pressure, blood D-lactic acid, and diamineoxidase (DAO) concentrations were examined.ResultsThe alteration in heart rate and systolic pressure in the low-pressure group 3 were significantly less than those in the pneumoperitoneum group (P<005). The airway pressure and PETCO2 were significantly lower in the low-pressure group 3 than the pneumoperitoneum group (P<0.05). The operative time in the gasless group were significantly longer than those in the pneumoperitoneum group and three low-pressure groups (P<0.05). There was no significant difference among the three low-pressure groups and the pneumoperitoneum group in operative time (P>0.05). There was no significant difference in D-lactic acid and diamineoxidase among the 5 groups (P>0.05).ConclusionsLaparoscopic cholecystectomy with low-pressure abdominal wall lifting (4-6 mm Hg) does not affect the respiratory and circulatory functions, and provides better surgical fields and reduces the operation duration. It is worthy of being popularized and applied in the elderly patients with cholecystectomy.

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备注/Memo

备注/Memo:
基金项目：上海市西医引导类科委课题（KW-201556302）；上海市重点专科胃肠外科（ZK2015B10）**通讯作者，E-mail：916630536@qq.com①消化内科
更新日期/Last Update: 2018-09-30