不同气腹压力腹腔镜胆总管探查术对老年患者呼吸循环功能及围术期影响的临床随机对照研究

A clinical randomized controlled trial:the effects of different pneumoperitoneum pressures on operation and cardioresperatory function of elderly patients with laparoscopic common bile duct exploration

目的探讨低腹压与标准腹压腹腔镜下胆总管探查术(LCBDE)对老年患者呼吸循环功能与手术的影响。方法采用随机对照研究方法,将2015年1月至2017年12月符合纳入标准的62例胆囊结石合并胆总管结石患者患者随机分为低腹压组(n=30)和标准腹压组(n=32)。比较2组患者气腹前后呼吸循环指标、手术情况及术后并发症的差异。结果标准腹压组气腹后30min的心率、气道峰压(PAP)明显高于低腹压组([80.03±7.49)次/minvs(75.13±7.63)次/min,P<0.05;(20.78±1.91)cmH2Ovs(19.53±2.62)cmH2O,P<0.05];低腹压组手术时间较标准腹压组明显延长([77.47±12.63)minvs(71.25±10.01)min,P<0.05],胆漏发生率高于标准腹压组(23.33%vs3.12%,P<0.05)。其余呼吸循环指标、手术情况、术后出血、结石残留等术后并发症差异无统计学意义(P>0.05)。结论标准腹压下行LCBDE对老年人呼吸循环功能影响比低腹压下大,但仍安全可行,降低CO2腹压可能增加胆漏等术后并发症。

Objective To explore the effects of different pressure of carbon dioxide pneumoperitoneum under laparoscopic common bile duct exploration to operation and cardioresperatory function of elderly patients.Methods 62 patients with cholecystolithiasis complicated with choledocholithiasis were selected from January 2015 to December 2017,who were in accordance with the inclusion criteria,were prospectively randomized into standard pneumoperitoneum pressure group(SP group,n=32)or low pneumoperito- neum pressure group(LP group,n=30).Operative outcomes,postoperative complications and the levels of cardioresperatory function were analyzed.Results In patients who received low pneumoperitoneum,decreased levels of HR and PAP after pneumoperitoneum development were found compared with the control group significantly[(80.03±7.49)/min vs(75.13±7.63)/min,P<0.05;(20.78±1.91) cmH2O vs(19.53±2.62)cmH2O,P<0.05];Patients in LP group had a long mean operative time and higher rates of bile leakage than in SP group[(77.47±12.63)min vs(71.25±10.01)min,P<0.05;23.33% vs 3.12%,P<0.05],No difference was found between the two groups in the other the levels of cardioresperatory function,operative outcomes and postoperative complications.Conclusion The effect of laparoscopic common bile duct exploration of low pneumoperitoneum pressure for elderly patients on the levels of cardioresperatory and liver function were significantly less than standard pneumoperitoneum pressure,but the rates of bile leakage was higher than standard pneumoperitoneum pressure;Laparoscopic common bile duct exploration of standard pneumoperitoneum pressure for elderly patients is a feasible,safe procedure.