膈肌超声评估胃肠道肿瘤腹腔镜术后膈肌功能变化及肺部并发症的研究

Study on diaphragmatic ultrasound in evaluating diaphragmatic function changes and pulmonary complications after laparoscopic surgery for gastrointestinal tumors

目的 通过超声评估胃肠道肿瘤腹腔镜术后膈肌功能和肺部超声的变化,探讨腹腔镜手术对膈肌功能、术后肺部并发症的影响.方法 选取2022年7月-2023年11月我院行腹腔镜手术的胃肠道肿瘤患者80例纳入腹腔镜手术组,另选取我院同期行传统开腹手术的胃肠道肿瘤患者50例纳入传统手术组.比较两组术前、术后24小时、术后48小时膈肌移动度(DE)、膈肌增厚率(DTF)、膈肌功能指标[深吸气末膈肌厚度(TDImax)、深呼气末膈肌厚度(TDEmax)、平静吸气末膈肌厚度(TDI)、平静呼气末膈肌厚度(TDE)]及肺部并发症总发生率.结果 术后24h、术后48h,两组TDI、TDE、TDImax、TDEmax较术前减小后逐渐增大,且腹腔镜手术组TDI、TDE、TDImax、TDEmax大于同时间点传统手术组(P<0.05).术后24h、术后48h,两组DTF较术前降低后逐渐升高,且腹腔镜手术组DTF高于同时间点传统手术组(P<0.05).术后24h、术后48h,两组DE降低后逐渐升高,且腹腔镜手术组DE高于同时间点传统手术组(P<0.05).腹腔镜手术组肺部并发症总发生率为11.25%,低于传统手术组的26.00%(P<0.05).结论 膈肌超声可有效评估胃肠道肿瘤腹腔镜术后膈肌功能变化和肺部并发症情况.

Objective To evaluate the diaphragmatic function and pulmonary ultrasound changes after laparoscopic surgery for gastrointestinal tumors using ultrasound,and to explore the effect of laparoscopic surgery on diaphragmatic function and postoperative pulmonary complications.Methods A total of 80 patients with gastrointestinal tumors who underwent laparoscopic surgery at our hospital from July 2022 to November 2023 were selected(Laparoscopic Surgery Group),and 50 patients with gastrointestinal tumors who underwent traditional open surgery during the same period at our hospital were selected(Traditional Surgery Group).The diaphragmatic excursion(DE),diaphragmatic thickening fraction(DTF),diaphragmatic function indicators[maximum inspiratory diaphragmatic thickness(TDImax),maximum expiratory diaphragmatic thickness(TDEmax),end-inspiratory diaphragmatic thickness(TDI),end-expiratory diaphragmatic thickness(TDE)]and the total incidence rate of pulmonary complications were compared between the two groups preoperatively and at 24 hours and 48 hours postoperatively.Results At 24 hours and 48 hours postoperatively,TDI,TDE,TDImax and TDEmax in both groups decreased and then gradually increased compared to preoperative levels,and the Laparoscopic Surgery Group had higher TDI,TDE,TDImax and TDEmax than the Traditional Surgery Group at the same time points(P<0.05).At 24 hours and 48 hours postoperatively,DTF in both groups decreased and then gradually increased compared to preoperative levels,and the Laparoscopic Surgery Group had a higher DTF than the Traditional Surgery Group at the same time points(P<0.05).At 24 hours and 48 hours postoperatively,DE in both groups decreased and then gradually increased,and the Laparoscopic Surgery Group had a higher DE than the Traditional Surgery Group at the same time points(P<0.05).The total incidence rate of pulmonary complications in the Laparoscopic Surgery Group was 11.25%,which was lower than the 26.00%in the Traditional Surgery Group(P<0.05).Conclusion Diaphragmatic ultrasound can effectively evaluate the changes in diaphragmatic function and pulmonary complications after laparoscopic surgery for gastrointestinal tumors.