超低气腹压辅助悬吊在腹腔镜结肠全系膜切除术(CME)中的应用

Application of Low-pressure Pneumoperitoneum Aided Suspended Laparoscopic Cholecystectomy for the Complete Mesocolic Excision(CME)

目的:探讨超低气腹压辅助悬吊在腹腔镜结肠全系膜切除术(CME)中应用的可行性和临床价值。方法:选择2016年9月1日至2018年9月1日在我院接受腹腔镜CME手术的50例结肠癌患者,将其随机分为正常气腹压力组(Ⅰ组)与超低气腹压组(Ⅱ组),每组各25例。观察和比较两组患者的术中各时间点血流动力学和血气分析指标、术中出血量、术后排气时间、术后住院时间、术后并发症发生情况以及手术切除范围和标本质量。结果:两组患者气腹前平均动脉压(mean arterial pressure, MAP)、心率(heart rate, HR)、动脉血二氧化碳分压(partial pressure of carbon dioxide in artery, PaCO_2)、血氧分压(partial pressure of oxygen, PaO2)比较差异均无统计学意义(P>0.05);两组患者平卧位气腹后15、30、60、120 min时MAP、HR、PaCO_2逐渐升高,PaO2逐渐下降,其中气腹后30、60、120 min时与气腹前比较差异均具有统计学意义(P<0.05);气腹结束时,两组患者的MAP、HR、PaCO_2均下降,PaO2升高,Ⅱ组患者基本恢复气腹前水平,Ⅰ组患者与气腹前比较差异均具有统计学意义(P<0.05)。Ⅰ组患者气腹30、60、120 min时MAP、HR、PaCO_2均显著高于Ⅱ组(P<0.05),而PaO2显著低于Ⅱ组(P<0.05)。Ⅱ组术中出血量、排气时间及住院时间均明显低于Ⅰ组(P<0.05),而Ⅰ组术后并发症发生率明显高于Ⅱ组(P<0.05)。两组患者切除平面、肿瘤距切缘的距离和巴结清扫数目比较差异无统计学意义(P>0.05)。结论:超低气腹压辅助悬吊在腹腔镜结肠全系膜切除术(CME)中的应用具有可行性,对患者心肺功能的影响较小,且正常气腹压力CME疗效基本相同,可成为老年患者尤其是伴有心肺疾患者的一种选择。

Objective: To explore the application of low-pressure pneumoperitoneum aided suspended laparoscopic cholecystectomy for the CME. Methods: From September 1 2016 to September 1 2018, 50 cases of colon cancer patients treated by CME were selected and randomly divided into two groups: normal pneumoperitoneum pressure group(groupⅠ) and low pressure pneumoperitoneum group(group Ⅱ), with 25 cases in each group. The hemodynamics and blood gas analysis index, intraoperative blood loss, postoperative exhaust time, postoperative hospital stay, postoperative complications and surgical removal of the range and quality of specimens of two groups were compared at each time point. Results: There was no statistically significant difference in the MAP, HR,PaCO2, and PaO2 between the two groups(P <0.05). At 15, 30, 60, 120 min after pneumoperitoneum, the MAP, HR, PaCO2 of both groups gradually rised, PaO2 gradually declined, including 30, 60, 120 min after pneumoperitoneum with comparison before pneumoperitoneum(P<0.05). At the end of the pneumoperitoneum, both groups showed a decrease in the MAP, HR, PaCO2, as well as an increase in the PaO2. The resumption of pneumoperitoneum of group Ⅱ returned to the basic level, while groupⅠ had statistically significant difference(P< 0.05). The MAP, HR and PaCO2 were significantly higher in groupⅠ than those in group Ⅱ(P < 0.05), while PaO2 was significantly lower than that of group Ⅱ(P<0.05). The amount of bleeding, exhaust time and length of hospitalization in group Ⅱ were significantly lower than those in groupⅠ(P<0.05), while the incidence of postoperative complications in group Ⅱ was significantly lower than that in groupⅠ(P<0.05). There was no statistically significant difference in the removal of the plane, the distance between the tumor margins and the number of the obturator clearance between the two groups of patients(P <0.05). Conclusions: Low pneumoperitoneum pressure auxiliary suspension is feasible for CME with less effect on the cardiopulmonary function, and the curative effect was basically equal to the normal pneumoperitoneum pressure CME, which is a choice especially for the elderly patients with cardiopulmonary disease.