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

Laparoscopic Cholecystectomy With Low-pressure Abdominal Wall Lifting in Elderly Patients

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5min心率、收缩压、呼气末CO_2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CO_2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(4~6mm 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。

Objective To evaluate the value of laparoscopic cholecystectomy with low-pressure abdominal wall lifting in elderly patients. Methods From 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, P ET CO 2, operation duration, airway pressure, blood D-lactic acid, and diamineoxidase （DAO） concentrations were examined. Results The 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 P ET CO 2 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）. Conclusions Laparoscopic 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.