低压气腹与标准气腹对腹腔镜胆囊切除术围术期影响的比较研究

Effects of low-pressure vs standard-pressure pneumoperitoneum on perioperative outcomes of laparoscopic cholecystectomy

目的分析低压气腹和标准气腹对腹腔镜胆囊切除术患者围术期的影响，探索低压气腹腹腔镜胆囊切除术的可行性。方法将实施腹腔镜胆囊切除术的92例胆囊结石患者分为低压气腹组和标准气腹组，两组患者分别为43和49例，术中低压气腹压力和标准气腹压力分别为8mmHg和12mmHg，观察并比较两组患者术中PaO2、术后视觉模拟疼痛评分（VAS）、术后使用镇痛药患者比例、手术时间、住院时问、术中和术后并发症发生率。结果低压气腹组术中PaO2、术后VAS、术后使用镇痛药患者比例及住院时间方面均优于标准气腹组（均P〈005），而两组手术时间、术中和术后并发症发生率的差异均无统计学意义（均P〉0．05）。结论低压气腹腹腔镜胆囊切除术与标准气腹腹腔镜胆囊切除术相比，可以明显减轻患者术后疼痛和缩短术后住院时间，而手术时间和术后并发症发生率等方面无明显差异。因此，低压气腹腹腔镜胆囊切除术是安全可行的，有利于患者术后恢复。

Objective To compare the perioperative outcomes between low-pressure pneumoperitoneum and stan- dard-pressure pneumoperitoneum in Japaroscopic cholecystectomy. Methods Ninety two patients with cholecystolithiasis were randomly assigned to receive elective laparoscopic cholecystectomy with low-pressure （8mmHg） pneumoperitoneum（n=43） or with standard-pressure（12mmHg） pneumoperitoneum（n=49）. The introoperative PaO2, postoperative visual analogue score of pain （VAS）, analgesics requirement, operation time, duration of hospitalization, intraoperative and postoperative complications were observed and compared between two groups. Results Intraoperative PaO2 level, postoperative VAS, analgesic require- ment and hospital stay in low-pressure group were significantly lower than those in standard-pressure group（P〈0.05 ）. There was no difference between two groups for operation time, intraoperative and postoperative complications. Conclusion Low-pressure pneumoperitoneum is safe and feasible in laparoscopic cholecystectomy with advantages of less postoperative pain and shorter hospital stay.