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中华疝和腹壁外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 286 -289. doi: 10.3877/cma.j.issn.1674-392X.2022.03.009

临床论著

低气腹压在老年患者腹腔镜完全腹膜外疝修补术中的应用
杨程1, 周绍荣2, 范从彬3,()   
  1. 1. 225300 江苏省,泰州市中医院泌尿外科
    2. 225300 江苏省,泰州市中医院普外科
    3. 226599 江苏省,如皋市中医院泌尿外科·普外科
  • 收稿日期:2021-12-29 出版日期:2022-06-20
  • 通信作者: 范从彬

Application of low pneumoperitoneum pressure in TEP for elderly patients

Cheng Yang1, Shaorong Zhou2, Congbin Fan3,()   

  1. 1. Department of Urology, Taizhou Hospital of Traditional Chinese Medicine, Taizhou 225300, Jiangsu Province, China
    2. Department of General Surgery, Taizhou Hospital of Traditional Chinese Medicine, Taizhou 225300, Jiangsu Province, China
    3. Department of Urology, Department of General Surgery, Rugao Traditional Chinese Medicine Hospital, Rugao 226599, Jiangsu Province, China
  • Received:2021-12-29 Published:2022-06-20
  • Corresponding author: Congbin Fan
引用本文:

杨程, 周绍荣, 范从彬. 低气腹压在老年患者腹腔镜完全腹膜外疝修补术中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(03): 286-289.

Cheng Yang, Shaorong Zhou, Congbin Fan. Application of low pneumoperitoneum pressure in TEP for elderly patients[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(03): 286-289.

目的

探讨6mmHg(1 mmHg=0.133 kPa)气腹压在腹腔镜完全腹膜外疝修补术(TEP)中的应用。

方法

第一阶段将60例心肺功能良好、年龄<75岁的非高龄单侧腹股沟斜疝患者随机分为A、B组,每组30例。A组气腹压力设定为14 mmHg,B组气腹压力设定6 mmHg,比较2组手术医师的手术视野满意度、手术时间、气腹时间、手术麻醉期不同时间点的气道压及呼气末二氧化碳分压(PETCO2)、出院时间、手术并发症发生率。

结果

3组患者住院时间差异无统计学意义(P>0.05)。在手术时间和气腹时间方面,与A组相比,B组和C组均略长,差异有统计学意义(P<0.05),B组和C组之间差异无统计学意义(P>0.05)。A组手术视野满意度(4.30±0.65)分优于B组(4.28±0.63)分、C组(4.42±0.64)分,差异均有统计学意义(P<0.05);B组与C组手术视野满意度差异无统计学意义(P>0.05)。3组患者术后并发症发生率比较,差异均无统计学意义(P>0.05)。3组患者T1、T2及T3的Paw及PETCO2与同组T0比较,差异均有统计学意义(P<0.05)。B组和C组T1、T2及T3的Paw及PETCO2与A组比较,差异均有统计学意义(P<0.05);其余指标比较,差异均无统计学意义(P>0.05)。

结论

6 mmHg低气腹压TEP手术用于部分高龄以及心肺功能较差的患者,可以确切降低术中气道压及PETCO2,增加手术安全性及耐受性,虽轻度影响手术的操作视野及空间,但并不影响手术的顺利完成,术后并发症的发生率及出院时间未受明显影响。

Objective

To investigate the application of 6mmHg (1 mmHg=0.133 kPa) pneumoperitoneum pressure in laparoscopic total extraperitoneal hernia repair (TEP).

Methods

In the first stage, 60 non elderly patients with unilateral indirect inguinal hernia and good cardiopulmonary function and less than 75 years old were randomly divided into group A and B, with 30 patients in each group. The pneumoperitoneum pressure in group A was set at 14mmHg, and that in group B was set at 6mmHg. The satisfaction of the surgical field of surgeons, the operation time, the pneumoperitoneum time, the airway pressure at different time points during the anesthesia period, the end expiratory PaCO2, the discharge time, and the incidence of surgical complications were compared between the two groups.

Results

There was no significant difference in hospital stay among the three groups (P>0.05). In terms of the operation time and pneumoperitoneum time, compared with group A, group B and group C were slightly longer, the difference was statistically significant (P<0.05), and there was no significant difference between group B and group C (P>0.05). The satisfaction with surgical field in group A (4.30±0.65) points was significantly higher than that in group B (4.28±0.63) points (P<0.05). The satisfaction with surgical field of group A was better than that of group C (4.42±0.64) points, the difference was statistically significant (P<0.05). There was no significant difference in satisfaction wi points h surgical field between group B and group C (P>0.05). There was no significant difference in the incidence of postoperative complications among the three groups (P>0.05). The paw and PetCO2 of T1, T2 and T3 in the three groups were significantly different from that of the same group of T0 (P<0.05). The paw and PetCO2 of T1, T2 and T3 in group B and C were significantly different from those in group A (P<0.05). There was no significant difference in other indexes (P>0.05).

Conclusion

For some elderly patients with poor cardiopulmonary function such as chronic bronchiolitis and emphysema, TEP with 6 mmHg low abdominal pressure can definitely reduce the intraoperative airway pressure and end respiratory PaCO2, and increase the safety and tolerance of the operation. Although it slightly affects the operation field and space, it does not affect the smooth completion of the operation, and the incidence of postoperative complications and discharge time are not significantly affected.

表1 3组患者一般资料比较
表2 3组患者手术相关数据资料比较(±s
表3 3组患者术后并发症发生率比较(例)
表4 3组患者不同时间点的气道压力比较(cmH2O)
表5 3组患者不同时间点的呼气末二氧化碳分压比较(mmHg)
[1]
唐健雄. 成人腹股沟疝诊疗指南(2018年版)解读[J]. 临床外科杂志, 2019, 27(1): 14-17.
[2]
朱鸣雷, 黄宇光, 刘晓红, 等. 老年患者围手术期管理北京协和医院专家共识[J]. 协和医学杂志, 2018, 9(1): 36-41.
[3]
Sunamak O, Donmez T, Yildirim D, et al. Open mesh and laparoscopic total extraperitoneal inguinal hernia repair under spinal and general anesthesia[J]. Ther Clin risk Manag, 2018, 14: 1839-1845.
[4]
刘格琳, 刘俊英. 腹腔镜手术中CO2气腹对机体的影响[J]. 河南科技大学学报(医学版), 2005, 23(1): 79-80.
[5]
李航宇. 指南或共识中老年腹股沟疝诊治相关建议与空白[J]. 中国实用外科杂志, 2018, 38(8): 894-897.
[6]
Kockerling F, Stechemesser B, Hukauf B, et al. TEP versus Lichtenstein: Which technique is better for the repair of primary unilateral inguinal hernias in men[J]. Surg Endosc, 2016, 30(8): 3304-3313
[7]
姜井颂, 张锡山, 钟先荣, 等. 腹腔镜下腹股沟疝修补术的术式选择与效果[J]. 中国普通外科杂志, 2012, 21(2): 196-199.
[8]
刘雨辰, 朱熠林, 陈杰, 等. 不同腹腔镜腹股沟疝修补术中二氧化碳气腹对酸碱平衡影响随机对照研究[J]. 中国实用外科杂志, 2021, 41(4): 415-418.
[9]
Gurusamy KS, Vaughan J, Davidson BR. Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy[J]. Cochrane Database Syst Rev, 2014, 18(3): CD006930.
[10]
唐小兵, 张超, 周涛, 等. 不同CO2压力对腹腔镜直肠癌根治术患者术中应激反应及胃肠功能的影响[J]. 局解手术学杂志, 2020, 29(4): 308-312.
[11]
李前辉, 王玲, 吴青华, 等. 高龄患者行腹腔镜直肠癌根治术CO2气腹对循环及呼吸功能的影响[J]. 西南国防医药, 2011, 21(9): 968-971.
[12]
朱泽飞, 孙振涛, 杨贯宇, 等. 长时间CO2气腹和Trendelenburg体位对中老年患者直肠癌根治术中脑氧饱和度的影响[J]. 临床麻醉学杂志, 2020, 36(2): 152-155.
[13]
Meftahuzzaman SM, Islam MM, Chowdhury KK, et al. Haemodynamic and end tidal CO changes during laparoscopic cholecystectomyunder genernal anaesthesia[J]. Mymensingh Med J, 2013, 22(3): 473-477.
[14]
沈雄飞, 江礼娟, 马冬华, 等. 腹腔镜下全腹膜外修补术治疗腹股沟疝的学习曲线[J]. 重庆医学, 2017, 46(19): 2662-2664.
[15]
Xue H, Zhang G, Han T, et al. Improvement of gel properties and digestibility of the water-soluble polymer of tea polyphenol-egg white under thermal treatment.[J]. Food Chem, 2022, 372: 131319.
[16]
文雯. 老年人经腹腔或后腹腔镜下泌尿外科手术期间呼吸循环参数及动脉血气的变化[D]. 四川泸州: 西南医科大学硕士学位论文, 2017.
[17]
Soto RG, Davis M, Faulkner MJ. A comparison of the incidence of hypercapnea in non-obese and morbidly obese peri-operativepatients using the SenTec transcutaneous pCO(2) monitor[J]. J Clin Monit Comput, 2014, 28(3): 293-298.
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