非气腹腹腔镜胆囊切除术中影响手术操作空间的相关因素分析  

Analysis of relative factors on the working space for operations in gasless laparoscopic cholecystectomy

作　　者：历延明[1] 张重阳[1] 周立芳[1] 田志强[1] 田霖[1] 

机构地区：[1]沧州中西医结合医院肝胆外科,沧州061001

出　　处：《国际外科学杂志》2012年第1期20-22,共3页International Journal of Surgery

摘　　要：目的研究非气腹腹腔镜胆囊切除手术中影响手术操作空间的相关因素。探讨非气腹腹腔镜手术的应用规范。方法总结2007年3月～2010年7月沧州中西医结合医院完成的49例非气腹腹腔镜胆囊切除术患者的临床资料。分析体重指数、肠道准备情况、麻醉方式等因素对手术时间、手术中转气腹率的影响。结果体重指数≤25的患者手术时间为（43．0±5．4）min，中转气腹率为0（0／34），体重指数〉25的患者手术时间为（52．8±7．4）min，中转气腹率为26．67％（4／15），明显高于体重指数小于25的患者；进行肠道准备的患者手术时间为（44．5±5．4）min，中转气腹率为7．69％（2／26），术前没有进行肠道准备的患者手术时间为（46．1±8．0）min，中转气腹率为8．70％（2／23）；采用硬膜外麻醉的患者手术时间为（46．5±7．9）min，中转气腹率为8．33％（2／24），腰麻加硬膜外联合麻醉的患者手术时间（44．1±6．8）min，中转气腹率为8．00％（2／25）。结论非气腹腹腔镜胆囊切除术手术操作空间容易受到体重指数等因素的影响，准确评价患者的自身状况，合理选择手术方式、麻醉方式、恰当应用肠道准备，可以更好地发挥非气腹腹腔镜手术的优势。Objective To investigate the potential factors which have impact on the working space for surgeons in gasless laparoscopie cholecystectomy and to probe into the specifications of gasless surgeries. Methods Clinical data of 49 cases of gasless laparoscopic cholecystectomy between March 200＂7 and July 2010 were summarized. The impacts of body mass index, bowel preparation and means of anesthesia on operation time and conversion to laparotomy were analyzed. Results For patients with body mass index ≤25 and 〉 25, operation times were （43.0 ± 5.4 ） min, and （52.8 ± 7.4 ） min, respectively, and rates of conversion to laparotomy were 0/34 and 4/15, respectively. Both indices in the first group were higher. For patients with and without bowel preparation, operation times were （ 44.5 ± 5.4） rain and （ 46. 1 ± 8. 0） min, respectively, and rates of conversion to laparotomy were 2/26 and 2/23, respectively. For patients with epidural anesthesia and lumbar/epidural anesthesia, operation times were （46.5 ± 7.9） min and （44.1 ± 6.8） min, respectively, and rates of conversion to laparotomy were 2/24 and 2/25, respectively. Conclusions The operation time of gasless laparoscopic cholecystectomy could be affected by many factors, such as body mass index. Gasless operations can be improved by evaluating the conditions of patients correctly and by selecting suitable operation methods, anesthesia means and bowel preparation.

关 键 词：腹腔镜 非气腹 胆囊 

分 类 号：R657.4[医药卫生—外科学]