二氧化碳气腹对TEP与TAPP的围手术期影响及管理综述

Perioperative Effects and Management Overview of Carbon Dioxide Pneumoperitoneum on TEP and TAPP

腹股沟疝是通过先天缺损或者老年人腹股沟区腹壁力量减弱造成腹腔脏器通过缺损移位,造成腹股沟区坠胀感、甚至造成肠梗阻、肠坏死等症状,严重影响患者生命安全。据相关统计学资料统计,我国每年有超过100万例的腹股沟疝修补术需要开展,数量甚至大于欧美和美国相同疾病的总和。目前采用的主要微创的手术方式为TEP、TAPP,但TEP、TAPP两种手术方式创建的操作空间不同,多项研究发现两者对二氧化碳气腹的反应存在差异,本综述就二氧化碳对机体的循环、呼吸、消化系统等方面的影响,以及通过麻醉药物的选择、手术方式的选择、气腹压的选择、术后镇痛、呼吸道管理等围手术的管理来降低二氧化碳气腹的影响。Inguinal hernia is caused by congenital defect or the weakening of abdominal wall strength in the inguinal region of the elderly, which causes the displacement of abdominal organs through the defect, resulting in a sense of bulge in the inguinal region, even causing intestinal obstruction, intestinal necrosis and other symptoms, which seriously affects the life safety of patients. According to relevant statistical data, there are more than 1 million cases of inguinal hernia repair in China every year, and the number is even greater than the sum of the same diseases in Europe, America and the United States. The main minimally invasive surgical methods currently used are TEP and TAPP, but the operating space created by the two surgical methods of TEP and TAPP is different. A number of studies have found that there are differences in the response to carbon dioxide pneumoperitoneum. This review focuses on the effects of carbon dioxide on the body’s circulation, respiration, digestive system and other aspects, as well as the choice of anesthetic drugs, the choice of surgical methods, the choice of pneumoperitoneum pressure, postoperative analgesia, respiratory management and other perioperative management to reduce the impact of carbon dioxide pneumoperitoneum.