悬吊式非气腹与气腹经脐单一部位切口腹腔镜胆囊切除术的临床对比研究  

Clinical Comparison Between Suspended Gasless and Traditional Transumbilical Single-site Laparoscopic Cholecystectomy

作　　者：李国伟 方海星 李桂芬 温怡洪 何静 邵锦晖 夏群峰 唐晓明 袁年勇 姜正科 何佳声 闻立平 

机构地区：[1]富阳市人民医院肝胆外科,富阳311400

出　　处：《中国微创外科杂志》2015年第9期793-797,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：2013年浙江省杭州市科技发展引导计划项目

摘　　要：目的探讨悬吊式非气腹经脐单一部位腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的临床应用价值。方法回顾性分析2012年5月-2013年5月气腹经脐单一部位LC 32例（气腹组）和悬吊式非气腹经脐单一部位LC 32例（非气腹组）的临床资料,比较2组患者术中平均动脉压（MAP）、气道峰值压力（PIP）、脉搏、血氧饱和度（Sp O2）、中心静脉压（CVP）和血气分析,手术时间,术中出血量,术后肛门排气时间,术后不适等并发症。结果 T1时点（麻醉后开始LC时）2组MAP、CVP、Sp O2均无统计学差异（P值均〉0.05）;气腹组PIP（24.7±4.1）cm H2O,明显高于非气腹组（15.7±2.9）cm H2O（t=-10.138,P=0.000）。T2时点（完成LC时）2组Sp O2无统计学差异（P〉0.05）;气腹组PIP（25.1±4.9）cm H2O,明显高于非气腹组（16.6±1.8）cm H2O（t=-9.211,P=0.000）;气腹组Pa CO2（57.2±3.5）mm Hg,显著高于非气腹组（37.5±3.4）mm Hg（t=-22.838,P=0.000）。2组患者术中出血量、手术时间均无统计学差异（P〉0.005）;非气腹组术后肠道功能恢复（肛门排气）时间显著早于气腹组（t=-7.637,P=0.000）,术后腹胀、恶心呕吐和肩背部疼痛的发生率显著低于气腹组（χ2=6.488,P=0.011;χ2=5.317,P=0.021）。结论改良悬吊式非气腹经脐单一部位LC对老年患者的呼吸、循环功能影响更小,术后恢复更快,并发症更少,手术安全性提高,值得推广。Objective To study the clinical application of suspended gasless transumbilical single port laparoscopic cholecystectomy（ LC）. Methods A retrospective analysis was made on clinical data of 32 cases of traditional transumbilical single port LC（ traditional group） and 32 cases of suspended gasless transumbilical single port LC（ gasless group） between May 2012 and May 2013. The intraoperative mean arterial pressure（ MAP）,peak airway pressure（ PIP）,pulse（ P）,oxygen saturation degree（ Sp O2）,central venous pressure（ CVP）,intraoperative blood gas analysis,operative time,blood loss,postoperative flatus after surgery,and postoperative discomfort were compared between the two groups. Results At the T1 timepoint（ from anesthesia to beginning of cholecystectomy）,differences in MAP,CVP,heart rate,and oxygen saturation had no statistical significance between the two groups（ P〉0. 05）,while the PIP was significantly higher in the traditional group（ 24. 7 ± 4. 1 cm H2O） than that in the gasless group（ 15. 7 ± 2. 9 cm H2O）（ t =- 10. 138,P = 0. 000）. At the T2 timepoint（ time to complete the laparoscopic cholecystectomy）,Sp O2 was not statistically significant between the two groups（ P 〉0. 05）,while the PIP was significantly higher in the traditional group（ 25. 1 ± 4. 9 cm H2O） than that in the gasless group（ 16. 6 ± 1. 8 cm H2O） with significant difference（ t =- 9. 211,P = 0. 000） and the Pa CO2 was significantly higher in the traditional group（ 57. 2 ± 3. 5 mm Hg） than that in the gasless group（ 37. 5 ± 3. 4 mm Hg）with significant difference（ t =- 22. 838,P = 0. 000）. The two groups had no significant differences in blood loss and operation time（ P 〉0. 05）. Compared with the traditional group,the gasless group had significantly earlier recovery of bowel functions（ t =- 7. 637,P = 0. 000） and significantly lower incidence of postoperative abdominal distention,nausea and vomiting,and shoulder back pain（ χ^2= 6. 488,P = 0. 011

关 键 词：单一部位 经脐手术 腹腔镜胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]