低压气腹腹腔镜技术在老年急性阑尾炎中的临床应用

Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic appendectomy in older patients

目的探讨低压气腹腹腔镜技术在治疗老年急性阑尾炎的临床疗效。方法回顾性分析2013年1月至2016年1月在我院住院治疗的104例老年急性阑尾炎,常规气腹腹腔镜技术治疗组52例,低压气腹腹腔镜技术治疗组52例,比较两组手术时间、术中出血量、术后并发症、住院时间,及对二氧化碳分压(PaCO_2)、N端脑钠肽(BNP)的影响。结果两组患者均顺利完成腹腔镜阑尾切除,无中转开腹。低压气腹组平均手术时间36.6±0.3 min与常规气腹组33.7±11.2 min相比无显著性差异(P=0.17);低压气腹组术中平均出血量40.1±5.3 m L较对常规气腹组38.5±4.3 m L增多,差异无统计学意义;低压气腹组住院时间3.2±1.2 d,较常规气腹组4.5±1.3 d缩短,差异具有统计学意义(P<0.01)。低压气腹组术后并发症2例,与对照组8例相比,差异具有统计学意义(P=0.046)。常规气腹组术后PaCO_2和BNP均较实验组显著升高,差异具有统计学意义(P<0.01)。结论低压气腹腔镜在治疗老年急性阑尾炎方面疗效确切,有利于术后快速康复及减少对心肺功能的影响,值得进行临床试用。

Objective To investigate the clinical effect of low pressure pneumoperitoneum laparoscopic technology in the treatment of acute appendicitis in the elderly. Methods 104 elderly patients with acute appendicitis were assigned to low pressure pneumoperitoneum laparoscopic technology（low pressure group） and the standard pressure（standard pressure group） pneumoperitoneum laparoscopic technology. The clinical effect was analyzed in two groups. And the operative time, blood loss, complications, postoperative hospital stay, PaCO_2 and BNP were considered between two groups.Results A total of 52 patients received low pressure gas laparoscopic technology and another 52 patients received the regular pressure gas laparoscopic technology. All patients were successfully received laparoscopic surgery. The operative time was 36.6 ±10.3 min in low pressure group, and33.7 ±11.2 min in standard pressure group（P =0.17）. Blood loss in low pressure group group（40.1 ±5.3 ml） was more than that in standanrd pressure group（38.5 ±4.3 ml）, but without statistics differences（P=0.09）. There were also no differences in complications, with two cases in low pressure group group, and 8 cases in standard pressure group（P =0.046）. However, there are significant differences in postoperative hospital stay（P〈0.01）, PaCO_2（P =0.016） and BNP（P =0.01） between two groups. Conclusion Low pressure pneumoperitoneum laparoscopic appendectomy in the elderly is feasible and safe, and with rapid recovery and less influences in respiratory and circulation system.