腹腔镜二氧化碳气腹致皮下气肿的临床分析

Clinical analysis of the subcutaneous emphysema due to laparoscopic carbon dioxide pneumoperitoneum

目的:探讨腹腔镜手术二氧化碳气腹致皮下气肿的原因、防治措施及处理方法。方法:回顾分析腹腔镜手术二氧化碳气腹导致皮下气肿187例患者的临床资料;其中64例重症患者气肿弥漫至肩、颈部或面部,PETCO2、Paw显著升高,SpO2下降,予以粗针头于气肿明显处穿刺抽气、降低气腹压力、增加潮气量、增快呼吸频率、尽快结束手术;123例轻症患者气肿局限于切口附近或肋缘胸壁,未特殊处理。结果:患者完全清醒,潮气量及呼吸频率恢复正常,PETCO2、SpO2指标正常后,拔除气管插管,皮下气肿于24～72 h后消失;合并气胸者行胸腔穿刺或闭式引流;2例患者拔管困难,转ICU。结论:术中规范操作,严密监测患者体征及SpO2、PETCO2等各项参数的变化,及时发现、正确处理皮下气肿,是避免发生不良后果的关键。

Objective：To investigate the reason, precaution and treatment of subcutaneous emphysema due to carbon dioxide pneumoperitoneum of laparoscopie surgery. Methods：Between 1996 and 2010, a retrospective analysis was made on clinical data of 187 cases of subcutaneous emphysema due to carbon dioxide pneumoperitoneum of laparoseopie surgery. 64 serious cases with massive subcutaneous emphysema of the face, neck and shoulder had significantly lower SpO2 and significantly higher PETCO2 and Paw. These patients were treated by thick needle puncture and air exhaust at obvious emphysema position and reducing pneumoperitoneum pressure. The tidal volume and respiratory rate was increased ,the operation was finished as soon as possible. 123 mild patients whose subcutane- ous emphysema was limited under the incision or chest wall at costal margin were not treated. Results ： All the patients regained full con- sciousness with normal tidal volume and respiratory rate. The tracheal intubation was removed after PETC02 and SpO2 was normal, and subcutaneous emphysema disappeared in 24-72 h. Patients with pneumothorax underwent thoraeentesis or thoracic close drainage. 2 patients who were difficult to remove the tracheal intubation were sent to ICU. Conclusions：The followings are suggested to avoid adverse consequence ：intraoperative standard manipulation, strict monitoring physical sign, and changes of data such as PET CO2 and SpO2 , timely and correct treatment of subcutaneous emphysema.