腹腔镜胃癌手术对下肢深静脉血流动力学的影响

Effects of laparoscopic surgery for gastric cancer on femoral venous hemodynamics

目的:探讨腹腔镜胃癌手术对下肢深静脉血流动力学的影响。方法:采用彩色多普勒超声检查测定15例腹腔镜胃癌手术过程中双下肢的股静脉直径、血流速度及血流量。结果:与气腹前平卧位相比,气腹后病人股静脉直径显著增大,平均血流速度及血流量均显著降低(P<0.01);气腹后取头高脚低位时,股静脉直径进一步增大,平均血流速度、血流量均进一步减少(P<0.05);术中,随着手术时间的延长,股静脉直径虽无明显变化(P>0.05),但平均血流速度及血流量均显著减少(P<0.05);至术毕CO2气体排出后、麻醉恢复前取平卧位时,股静脉直径变细(P<0.01),平均血流速度及血流量均显著增加(P<0.01),但仍未达到气腹前平卧位水平(P<0.05)。结论:腹腔镜胃癌手术CO2气腹的建立、头高脚低体位及手术时间的延长均可使病人下肢深静脉管径增大、血流速度减慢、血流量减少,血液回流受阻,致术后下肢深静脉血栓发生的风险增加,在围手术期应积极采取预防措施。

Objective To study the effects of laparoscopic surgery for gastric cancer on femoral venous hemodynamics. Methods In 15 patients undergoing laparoscopic gastric surgery, color Doppler ultrasonic examination was carried out to determine the diameter and blood flow rate of both femoral veins, as well as the resultant blood volume of both lower extremities. Results The diameter of the femoral veins increased, and the blood flow rate and blood volume decreased significantly after establishing the CO2 pneumoperitoneum （P〈0.01）. The three parameters persisted to develop further when the patients were turned to the feet-down tilt position with CO2 pneumoperitoneum （P〈0.05）. During the operation, the femoral vein diameter did not changed obviously（P〉0.05）, and the blood flow rate and blood volume kept on decreasing （P〈O.05）. At the end of operation, the diameter of the femoral vein decreased, and the blood flow rate and blood volume increased significantly （P〈O.01） when the patients were returned to the prostration position and the CO2 gas was totally expelled. Conclusions The C02 pneumoperitoneum, feet-down tilt position and operation time can interfere the blood circulation of the deep veins of lower limbs, with resulting femoral vein diameter increase and the blood flow rate and volume decrease during laparoscopic gastric surgery, which will increase the risk of deep vein thrombosis postoperatively.