持续排气法预防腹膜后入路腹腔镜手术皮下气肿的效果评价

Effects of Continuous Exhaust Ventilation on Prevention of Subcutaneous Emphysema after Retroperitoneal Laparoscopy

目的探讨保持气腹压力的持续排气法在预防经腹膜后入路腹腔镜手术皮下气肿的应用效果。方法以2020年10月至2021年9月收治于常州市第一人民医院经腹膜后入路行腹腔镜肾部分切除术的101例患者为研究对象。将其随机分为观察组(n=49)与对照组(n=52)。对照组术中使用常规人工间歇吸引排气法,观察组采用持续吸引排气法。比较两组患者术中气腹实际压力值、擦拭镜头次数、手术时间及术后皮下气肿的发生率、住院时间等指标。结果观察组49例患者中,有4例发生皮下气肿,且均为1~2级;对照组52例患者中,10例发生了1~2级皮下气肿,3例发生了3~4级皮下气肿;两组比较,差异有统计学意义(P<0.05)。且观察组术中擦拭镜头次数[(3.18±0.99)次]少于对照组[(6.41±2.91)次],手术时间[(135.73±45.40)min]及住院天数[(15.50±3.89)d]亦短于对照组[(158.71±61.95)min及(16.04±4.24)d],差异均有统计学意义(P<0.05)。另,术中持续腹压监测曲线图表明,观察组患者术中腹腔内实际气腹压力波动于11~13 mmHg,较对照组(5~18 mmHg)更趋于平稳。结论保持气腹压力稳定的持续排气法可明显提高腹膜后入路腔镜手术操作的流畅性,缩短手术时间,减少患者术后皮下气肿发生率,有一定推广应用价值。

Objective To explore the effects of continuous exhaust ventilation on the prevention of subcutaneous emphysema after retroperitoneal laparoscopy by maintaining pneumoperitoneum pressure.Methods From October 2020 to September 2021,101 patients who underwent retroperitoneal laparoscopic partial nephrectomy in the First People’s Hospital of Changzhou were selected.They were randomly divided into the observation group(n=49)and the control group(n=52).The control group was given routine manual intermittent exhaust ventilation in the surgery,while the observation group was given continuous exhaust ventilation.The actual pneumoperitoneum pressure,the times of wiping lens,the operation time,the incidence of postoperative subcutaneous emphysema and the length of hospital stay were compared between the two groups.Results Of the 49 patients in the observation group,4 developed subcutaneous emphysema,all of which were grade 1-2;of the 52 patients in the control group,10 developed grade 1-2 subcutaneous emphysema and 3 developed grade 3-4 subcutaneous emphysema;the difference between the two groups was statistically significant(P<0.05).The times of intraoperative wiping lenses in the observation group[(3.18±0.99)times]was less than that in the control group[(6.41±2.91)times],and the operation time[(135.73±45.40)min]and the length of hospital stay[(15.50±3.89)d]were also shorter than those in the control group[(158.71±61.95)min and(16.04±4.24)d],with statistically significant difference(P<0.05).In addition,the intraoperative abdominal pressure curve continuously monitored showed that the actual intra-abdominal pneumoperitoneum pressure fluctuated between 11 and 13 mmHg in the observation group,which tended to be more stable than that in the control group(5-18 mmHg).Conclusion Continuous exhaust ventilation is worthy of promotion to a certain degree as it is able to obviously improve the fluency of retroperitoneal laparoscopy,shorten the operation time and reduce the incidence of postoperative subcutaneous emphysema by keeping a stable pneumoperitoneum pressure.