摘要
目的探讨免气腹全腹腔镜下肝叶切除术应用的可行性。方法选择我院2008年5月～2009年12月资料完整的全腹腔镜下肝叶切除术22例,免气腹组11例(应用经穿刺孔8～14Fr导尿管腹壁牵拉技术),气腹组11例,进行回顾性对照研究,比较2组手术时间、术中出血量、术后腹腔引流量、术后胃肠功能恢复时间、术后恶心呕吐情况、术后住院时间、术后并发症,检测手术开始60min时动脉血CO2分压(PaCO2)、呼气末CO2分压(PETCO2)、中心静脉压(CVP)和气道压。结果2组手术均顺利,无中转开腹,无输血,术后恢复顺利。2组手术时间、术中出血量、术后腹腔引流量、肛门首次排气时间、术后住院时间、术后并发症差异均无显著性(P>0.05)。免气腹组手术开始60min时PaCO2[(36.0±4.0)mmHgvs(43.9±3.8)mmHg,t=4.735,P=0.000],PETCO2[(31.3±2.8)mmHgvs(41.2±3.8)mmHg,t=6.978,P=0.000],CVP[(6.04±1.62)cmH2Ovs(7.81±1.66)cmH2O,t=2.533,P=0.020]和气道压[(17.1±2.5)cmH2Ovs(25.1±3.9)cmH2O,t=5.711,P=0.000]明显低于气腹组。结论经穿刺孔皮管腹壁提拉技术开展免气腹全腹腔镜下肝叶切除术可行,安全。
Objective To explore the feasibility of Gasless laparoscopic liver lobectomy.Methods A total of 22 patients underwent laparoscopic liver lobectomy in our hospital from May 2008 to December 2009.Of the cases,gasless laparoscopy was used in 11 patients（8-14 Fr catheter was inserted through the abdominal wall puncture hole）and CO2-insufflated pneumoperitoneum were employed in the other 11 cases.The operation time,intraoperative blood loss,volume of intra-abdominal drainage,and postoperative recovery time of gastrointestinal function,nausea and vomiting,hospital stay,and complications were compared between the two groups.We detected the partial pressure of arterial CO2（PaCO2）,partial pressure of end-tidal CO2（PETCO2）,central venous pressure（CVP）,and airway pressure at 60 minutes after the beginning of the surgery in both the groups.The data were compared as well after the operation.Results Laparoscopic liver lobectomy was completed in both the groups successfully without conversion to open surgery,nor blood transfusion.No significant difference was detected in the operation time,intraoperative blood loss,postoperative abdominal drainage,time of the first postoperative anal exhaustion,and postoperative hospital stay and complications（P〉 0.05）.The PaCO2,PETCO2,CVP and airway pressure in the gasless group were significantly lower than those in the CO2-insufflated pneumoperitoneum group [PaCO2：（36.0±4.0）mm Hg vs（43.9±3.8）mm Hg,t=4.735,P=0.000;PETCO2：（31.3±2.8）mm Hg vs（41.2±3.8）mm Hg,t=6.978,P=0.000;CVP：（6.04±1.62）cm H2O vs（7.81±1.66）cm H2O,t=2.533,P=0.020;airway pressure：（17.1±2.5）cm H2O vs（25.1±3.9）cm H2O,t=5.711,P=0.000].Conclusions Gasless laparoscopic liver lobectomy is feasible and safe by inserting a catheter through the abdominal wall puncture hole using pulling technology.
出处
《中国微创外科杂志》
CSCD
2010年第5期391-394,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
免气腹腹腔镜
CO2气腹
肝叶切除术
对比研究
Gasless Laparoscopy
CO2-insufflated pneumoperitoneum
Liver lobectomy
Comparative study
