腹腔镜结直肠手术中CO2气腹对下肢静脉回流的影响

Effect of CO2 pneumoperitoneum on lower extremity venous flow in laparoscopic colorectal operations

目的 探讨腹腔镜结直肠手术CO2气腹对下肢静脉回流的影响,为腹腔镜手术围手术期采取必要措施预防深静脉血栓形成提供依据.方法 选取39例行腹腔镜手术的结直肠癌患者,分别于全麻后气腹建立前、气腹建立后20 min和气腹消除后20 min用彩色多普勒超声诊断仪测量股静脉截面积和最大血流速度.最后按年龄分为两组：A组20例,年龄≥60岁;B组19例,年龄＜ 60岁.比较两组不同手术时期股静脉血流动力学指标.结果 两组气腹建立后20 min股静脉截面积增大（P＜0.05）,血流速度和血流量减小（P＜0.05）;与B组相比,A组以上指标变化更明显,差异有统计学意义（P＜0.05）.两组在手术结束气腹消除后20 min股静脉截面积、血流速度均不同程度恢复,但未达到气腹前水平,三个测量点平均值比较差异有统计学意义（P＜0.05）.结论 腹腔镜结直肠手术CO2气腹使下肢静脉回流受阻,60岁以上患者变化更明显,老年患者需行腹腔镜结直肠手术时,应在围手术期采取措施预防深静脉血栓形成.

Objective To study the effect of CO2 pneumoperitoneum on lower extremity venous flow during laparoscopic colorectal operations and obtain references for perioperative measures in preventing deep venous thrombosis.Methods Thirty-nine patients with colorectal carcinoma who underwent laparoscopic surgery were enrolled.The femoral vein cross-sectional area and maximum velocity were measured by color Doppler ultrasound at each time point：followed anesthesia,20min after the establishment of pneumoperitoneum and 20min after its exhaustion.Based on the age,the cases were divided into group A （n =20,age ≥ 60y）and group B （n =19,age ＜ 60y）.The femoral vein hemodynamics indexes at each time point were compared between the 2 groups.Results In both groups,the femoral vein cross-sectional area increased significantly （P ＜ 0.05）,meanwhile the blood velocity and the volume of the blood flow decreased significantly（P ＜ 0.05） ; compared with group B,the above data in group A changed significantly （P ＜ 0.05）.In both groups,femoral vein cross-sectional area and blood velocity recovered instantly after the exhaustion of CO2 gas,but there were significantly differences in average values among the different time points（P ＜0.05）.Conclusion In laparoscopic colorectal surgery,CO2 pneumoperitoneum restricts the venous flow,especially in patients over 60 years.For elderly patients who need laparoscopic colorectal operations,measures should be taken to prevent deep venous thrombosis during the perioperative period.