食管病变内镜黏膜剥离术中灌注二氧化碳对术后恢复的影响

The effect of carbon dioxide insufflation on postoperative recovery during esophageal endoscopic submucosal dissection

目的探讨在全麻状态下行食管病变内镜黏膜剥离术术中灌注二氧化碳对术后机体恢复的影响。方法 2011年10月至2012年12月,对我院收治的接受食管黏膜剥离术治疗的患者72例,随机分成二氧化碳观察组和空气对照组。记录每个患者的手术时间,术后纵隔气肿或皮下气肿的发生例数以及气肿消退时间,术后住院时间。结果二氧化碳组和空气组的平均手术时间分别是(85±52)min和(87±55)min(P>0.05),纵膈气肿(CT提示)或皮下气肿的发生率分别是31%和33%(P>0.05)。二氧化碳组中发生气肿的患者术后气肿消退时间少于空气组,分别是(4.82±1.54)d和(5.83±1.8)d(P<0.05)。二氧化碳组术后平均住院天数少于空气组,分别是(6.1±1.3)d和(7.0±1.8)d(P<0.05)。结论食管病变的内镜黏膜剥离术中灌注二氧化碳气体能缩短术后恢复时间,提高术后恢复的质量。

Objective To explore the effect of carbon dioxide insufflation on postoperative recovery dur-ing esophageal endoscopic submucosal dissection with the patient under general anesthesia. Methods A total of 72 patients who received esophageal endoscopic submucosal dissection from October 2011 to December 2012 by randomly using carbon dioxide insufflation or air insufflation in the process of treatment were enrolled in this study.In this study,we used air insufflation as control. The operation time, the incidence of mediastinal emphysema or subcutaneous emphysema, the extinctive time of emphysema, and length of stay after operation were recorded. Results The mean operation time was 85 ± 52 minutes in CO2 group and （87 ± 55） minutes in air group（P〉0.05）. The incidence of mediastinal emphysema（CT revealed） or subcutaneous emphysema was 31%in CO2 group and 33%in air group （P〉0.05）. The time of emphysema extinction after operation was （4.82 ± 1.54） days in CO2 group, and （5.83 ± 1.8） days in control group , respectively （P〈0.05）. The mean hospital day after operation was （6.1 ± 1.3） days in CO2 group, shorter than （7.0 ± 1.8） days in air group （P〈0.05）. Conclusions CO2 insufflation during esophageal endoscopic submucosal dissection with the patient un-der general anesthesia might shorten the length of postoperative recovery time and improve quality of recovery.