不同麻醉方式下腹腔镜精索静脉高位结扎术疗效比较

Comparison of two anaesthesia of laparoscopic varicocelectomy for treatment of varicocele

目的比较硬脊膜外阻滞麻醉低气腹压与静吸复合全身麻醉高气腹压条件下腹腔镜治疗精索静脉曲张的临床效果。方法74例患者分为硬脊膜外阻滞麻醉低气腹压组(A组,n=42)和全身麻醉高气腹压组(B组,n=32)。对比观察两组患者术中配合情况、生命指标变化、手术时间、治疗效果及并发症等指标。结果两组患者的麻醉诱导和维持满意,术中血压、SpO2均无明显变化。A组患者气腹维持中及停气腹后心率明显减慢,呼吸频率明显加快;B组的心率、呼吸均无明显改变。A组血气指标较B组平稳。两组手术时间、术中出血量、术后住院时间、手术成功率及术后并发症发生率差异均无显著性,A组术后肠功能恢复时间显著低于B组。结论保持0.81～1.10kPa(6～8mmHg)气腹压力,在硬脊膜外阻滞麻醉下行腹腔镜精索静脉高位结扎术具有安全可靠、术后恢复快、节省医疗费用等优点。

[Objective] To compare the clinical results and value of laparoscopic varicocelectomy for the treatment of varicocele with low gas pressure and epidural block anesthesia with high gas pressure and general anaesthesia. [Methods] Seventy-four adult inpatients with varicocele, who had prepared to hold laparoscopic varicocelectomy were divided into A group （42 cases） and B group （32 cases）. A group was treated with low gas pressure and epidural block anesthesia and B group was treated with high gas pressure and general anaesthesia. The opera- tion process, changes of breath, blood pressure, SpO2 and heart rate during the operation, operation time, treatment result and complications were compared between two groups. [Results] In the group A, the HR was significantly lower after pneumoperitoneum and decompression of pneumoperitoneum than that of before operation; while the HR showed no markable change in before and after pneumoperitoneum in the Group B. The respiratory rate （RR） in the group A remarkably increased after pneumoperitoneum and remained at a high level after decompression of pneumoperitoneum. The operation time, treatment results and complications of the two groups had not significant difference. The enteric function resuming time of group A was significantly lower than group B. [ Conclusion] Laparoscopic varicocelectomy for the treatment of varicocele with low gas pressure and epidural block anesthesia is safe, brief and cost effective.