低腹压与标准腹压对老年患者腹腔镜胆总管探查术影响的临床随机对照研究

A clinical randomized controlled trial of the effects of different pneumoperitoneum pressures on laparoscopic common bile duct exploration for elderly patients

目的:探讨低腹压与标准腹压对老年患者腹腔镜胆总管探查术(LCBDE)的影响及其临床意义。方法:采用随机对照实验的方法,将2015年1月至2017年12月符合纳入标准的62例胆总管结石患者随机分为标准腹压组(SP组,n=32)与低腹压组(LP组,n=30)。对比分析两组患者气腹前后呼吸循环指标、应激反应指标、肝功能、术中及术后并发症等相关指标。结果:术前两组患者一般情况及肝功能差异无统计学意义。气腹后30 min,LP组心率、气道峰压均低于SP组(P=0.013,P=0.036);术后第3天,两组患者谷丙转氨酶、碱性磷酸酶值LP组低于SP组(P=0.006,P=0.024);术后第5天,LP组前白蛋白高于SP组(P=0.008); LP组手术时间长于SP组,胆漏发生率高于SP组(P=0.024,P=0.035)。两组患者其他呼吸循环指标、应激炎症反应指标、手术及术后并发症差异无统计学意义。结论:LCBDE术中应用标准腹压较低腹压对老年人影响大,但仍是安全、可行的,降低CO2气腹压力可能增加胆漏发生率。

Objective: To explore the effects and clinical significances of different pressure of carbon dioxide pneumoperitoneum on laparoscopic common bile duct exploration for elderly patients. Methods: From Jan.2015 to Dec.2017,62 patients with cholecystolithiasis complicated with choledocholithiasis,who were in accordance with the inclusion criteria,were randomly divided into standard pneumoperitoneum pressure group (SP group, n= 32) or low pneumoperitoneum pressure group (LP group, n= 30).The levels of cardiopulmonary function and stress reactions before and after pneumoperitoneum,liver function,intraoperative and postoperative complications were comparatively analyzed between the two groups. Results: The preoperative baselines and liver function of patients in two groups were not significantly different.At 30 min after pneumoperitoneum,heart rate ( P =0.013) and peak airway pressure ( P =0.036) in LP group was lower than that in SP group;alanine aminotransferase and alkaline phosphatase of LP group were significantly lower than those of SP group on the 3rd day after the operation ( P =0.006, P =0.024);prealbumin in LP group was significantly higher than that in SP group on the 5th day after the operation ( P =0.008).Patients in LP group had longer operative time and higher incidence of bile leakage than those in SP group ( P =0.024, P =0.035).No difference was found between the two groups in the other indicators of cardiopulmonary function,stress reactions,intraoperative or postoperative complications. Conclusions: The influence of standard pneumoperitoneum pressure in laparoscopic common bile duct exploration is more on elderly patients than low pneumoperitoneum pressure,but standard pneumoperitoneum pressure is still safe and feasible,the decrease of pneumoperitoneum pressure may increase the incidence of bile leakage.