腹腔镜和后腹腔镜切除术对肾上腺肿瘤患者的临床疗效、血气分析及血流动力学的影响

Laparoscopic and retroperitoneal laparoscopic resection of adrenal tumors in patients with cfin- ical efficacy,blood gas analysis and hemodynamic effects

目的探讨腹腔镜和后腹腔镜切除术对肾上腺肿瘤患者的临床疗效、血气分析及血流动力学的影响。方法选取2014年5月至2017年8月在本院和浙江省人民医院联合治疗的肾上腺肿瘤患者90例,根据手术方式的不同分为对照组和观察组,对照组43例,观察组47例。对照组患者进行腹腔镜手术,观察组进行后腹腔镜手术,分别对两组患者的临床疗效、气腹前(T1)、气腹后30min(T2)、气腹后60min(T3)及气腹结束后30min(T4)的血气分析及血流动力学指标进行检测。结果观察组患者术后引流量、术后住院时间及肠功能恢复时间均显著低于对照组,差异有统计学意义(P<0.05)。T2、T3时,两组患者MAP及HR水平均较T1时刻显著升高,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。T2、T3时,两组患者PaCO2水平较T1时显著升高,PH水平较T1时显著降低,差异有统计学意义(P<0.05)。PaO2水平与T1时刻相比差异无统计学意义(P>0.05)。观察组患者PaCO2水平显著高于对照组,PH水平显著低于对照组,差异有统计学意义(P<0.05)。T4时,两组患者PaCO2水平均较T2、T3时降低,PH水平较T2、T3时升高,且与T1时相比,差异无统计学意义(P>0.05)。T2、T3时,两组患者Na^+、HCO3^-水平均较T1时显著增加(P<0.05),K^+水平较T1时显著降低(P<0.05)。相同时刻,Na^+、K^+水平组间比较差异无统计学意义(P>0.05),而观察组患者HCO3^-水平显著大于对照组(P<0.05)。结论后腹腔镜手术能对肾上腺肿瘤切除患者较腹腔镜手术治疗效果更好,但对患者血气指标影响较大。

Objective To investigate the clinical effect, blood gas analysis and hemodynamics of patients with adrenal tumors undergoing laparoscopic and retroperitoneal laparoscopic resections. Methods Ninety patients with adrenal tumors were selected from May 2014 to August 2017 in our hospital and Zhejiang provincial people's hospital and divided into control group and observation group according to the different surgical methods, 43 cases in the control group and 47 cases in the observation group. The patients in the control group underwent laparoscopic surgery and the observation group underwent laparoscopic surgery. The clinical efficacy, blood gas analysis and hemodynamic indexes of the two groups before pneumoperitoneum (T1), 30 min after pneumoperitoneum (T2), 60 min after pneumoperitoneum (T3) and 30 min after pneumoperitoneum (T4) were respectively tested. Results The postoperative drainage, postoperative, hospital stay and intestinal function recovery time in the observation group were significantly lower than those in the control group (P<0.05), and there was no significant difference between the operation time and the control group (P>0.05). At T1, there was no significant difference in MAP and HR between the two groups (P>0.05). At T2 and T3, both MAP and HR levels were significantly higher than those at TI (P<0.05), But there was no significant difference between the two groups (P>0.05). At T4, MAP and HR in both groups were lower than those at T2 and T3, and there was no significant difference between the two groups (P>0.05), No significant difference between groups (P>0.05);There were no significant differences in PaCO2, PaO2 and PH levels between the two groups at T1 (P>0.05). At T2 and T3, the levels of PaCO2 in both groups were significantly higher than those in T1, and the levels of PH were significantly lower than those in T1 (P<0.05). There was no significant difference in PaO2 between T1 and T2 (P>0.05). The PaCO2 level in the observation group were significantly higher than those in the control group (P<0.05), and the PH level in the observation group were significantly lower than those in the control group (P<0.05), while the PaO2 levels in the observation group were not significantly different from those in the control group (P>0.05), PaCO2 levels in patients were lower than those in T2 and T3, PH levels were higher than those in T2 and T3, and there was no significant difference compared with T1 (P>0.05). There was no significant difference in PaCO2 between T2 and T3 statistical significance (P>0.05), no significant difference between groups (P>0.05). At T2 and T3, the levels of Na+ and HCO3^- in both groups were significantly increased compared with those in T1 and K^+ levels were significantly lower than those in T1 (P<0.05). At the same time, Na+ and K^+ (P>0.05). The level of HCO3- in the observation group was significantly higher than that in the control group (P<0.05). At T4 time, the levels of Na+ and HCO3-in both groups were lower than those at T2 and T3, T3 time increased, and compared with T1, the difference was not statistically significant (P>0.05). Conclusions Retroperitoneal laparoscopic surgery can produce an effective therapeutic effect on patients with adrenalectomized resection, but it has a greater impact on the patient's blood gas index and should monitor the patient's respiratory and blood gas indexes during surgery.