免气腹与二氧化碳气腹腹腔镜胆囊切除术的对比研究

Comparative study of gasless with carbon dioxide pneumoperitoneum laparoscopic cholecystectomy

目的探讨免气腹腹腔镜胆囊切除术(gasless laparoscopic cholecystectomy,GLC)的临床价值。方法将80例患胆囊结石、胆囊息肉或胆囊炎患者分成两组(A组和B组),A组行GLC(n=40),B组行二氧化碳气腹腹腔镜胆囊切除术(n=40),记录并比较两组手术时间、术后切孔感染、术后肩部疼痛情况;以及术前和手术30 min及手术结束10 min BP、HR、CVP、PaCO2、PetCO2、Paw、pH;术前术后CRP、IL-6、PT、APTT、Fib、TT、D-D二聚体、CK、LDH、HBOH、CK-MB、GOT、GPT、ALP、GGT、TBIL、BUN、Cr;术后下床活动时间、术后胃肠功能恢复时间、术后住院时间、住院费用等指标。结果 80例手术全部成功,B组术后6例肩部疼痛,A组无肩部疼痛(P<0.05);B组手术30 min及手术结束10 min时Bp、HR、PaCO2、PetCO2、Paw均高于A组,而pH、CVP降低(P<0.01);B组术后24 h CRP、IL-6、PT、APTT、Fib、D-D二聚体、CK、CK-MB、ALT、AST、Cr高于A组(P<0.01);术后72 h CRP、APTT、D-D二聚体、CK、ALT、AST高于A组(P<0.01);术后24 h、72 h BUN高于A组(P<0.05);术后24 h ALP高于A组(P<0.05)。B组住院费用比A组高(P<0.01)。结论免气腹腹腔镜手术对机体的心、肺、肝、肾功能、血气和凝血功能影响小,费用低,适应证广,具有较高的临床价值。

Objective To investigate the clinical value of gasless laparoscopic cholecystectomy（GLC）. Methods Eighty patients with gallbladder stones, gallbladder polyps, or cholecystitis patients were divided into two groups, one group underwent GLC （n = 40 ）, another group underwent carbon dioxide pneumoperitoneum laparoscopic cholecystectomy （ PLC, n = 40 ）. Operation time, postoperative incision infection, and postoperative shoulder pain of the two groups were recorded; BP, HR, CVP, PaCO2, PetCO2, Paw, and pH before operation, 30 minutes after the start of operation, and 10 rain after operation, as well as preoperative and postoperative CRP, IL-6, PT, APTY, Fib, tiT, D-two, CK, LDH dimer, HBOH, CK-MB, GOT, GPT ALP, GGT, TBIL, BUN, and Cr were measured. And ambulation after operation, postoperative gastrointestinal function recovery time, postoperative hospitalization time, and cost of hospitalization of the two groups were also observed and compared between the two groups. Results The operation was successfully completed in 80 cases, with 6 cases of postoperative shoulder pain in PLC group observed, but none in GLC group. （P 〈0.05） ; Thirty minutes after the start of operation, and 10 min after operation, BP, HR, PaCO2, PetCO2, Paw were higher and PH and CVP lower in PLC group than in GLC group （ P 〈 0.01 ） ; 24h after operation,CRP, IL-6, PT, APTY, Fib, D-two dimer, CK, CK-MB, ALT, AST, Cr in group PLC were higher than in GLC （P 〈0.01 ） ; 72h after operation, CRP, APTY, D-two dimer, CK, ALT, and AST were higher in PLC group than in GLC （P 〈 0.01 ） ; 24h and 72h after operation, BUN in PLC group was higher than in GLC group （ P 〈 0.05 ） ; 24h after operation, ALP was higher in PLC group than that GLC group（P 〈 O. 05 ）, and hospital costs in PLC group was higher than in GLC group （ P 〈 O. O1 ）. Conclusions GLC has less influence on heart, lung, liver, kidney function, blood gas, and coagulation function of the patients, with low cost, wide indications, and high clinical value.