腹腔镜结直肠手术中腹内压升高对急性胃肠损伤影响的前瞻性研究  

Effect of elevated intra-abdominal pressure on acute gastrointestinal injury in laparoscopic colorectalsurgery： a prospective study

作　　者：蔡正昊 郑民华[1] 孙晶[1] 潘睿俊[1] 马君俊[1] 冯波[1] 王明亮[1] 陆爱国[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普通外科,200025

出　　处：《中华消化外科杂志》2016年第1期64-70,共7页Chinese Journal of Digestive Surgery

基　　金：国家高技术研究发展计划（863计划）（2012AA021103）;上海卫生系统先进适宜技术推广项目（2013SY010）

摘　　要：目的探讨腹腔镜结直肠手术中c0：气腹压力升高对急性胃肠损伤（AGI）的影响。方法选取2014年1-6月上海交通大学医学院附属瑞金医院行腹腔镜结直肠手术的66例结直肠癌患者进行前瞻性研究，采用随机、双盲对照法，通过随机数将入组患者随机分为3组，分别为10mrnHg（1mmHg=0．133kPa）组、12mmHg组和15mmHg组。3组患者术中c02气腹压力分别设定为10mmHg、12mmHg和15mmHg。主要观察指标：记录患者术中情况、术后恢复情况、检测患者IL-6及TNF-α水平。正态分布的计量资料以x±s表示，组间比较采用单因素方差分析。非正态分布的计量资料以M（Qn）表示，采用非参数检验。计数资料以频数和百分比表示，组间比较采用，检验。结果筛选出符合研究条件的患者66例，3组各22例。研究过程中11例患者退出（10mmHg组3例、12mmHg组3例、15mmHg组5例）。3组患者术后6h内拔除鼻胃管的患者分别为19、18、14例，3组比较，差异无统计学意义（X^2=3．55，P〉0．05）。3组患者中分别有0、1、2例发生术后非AGI早期腹腔内并发症，3组比较，差异无统计学意义（r=5．82，P〉0．05），且均经保守治疗后治愈，无短期内再手术。15例患者出现AGI，其中AGII级8例，AGIⅡ级7例。10mmHg组、12mmHg组、15mmHg组患者AGI发生比例分别6／19、3／19、6／17，AGI严重程度AGII、Ⅱ级分别为2例和4例、2例和1例、4例和2例，3组比较，差异均无统计学意义（X^2=2．04，2．00，P〉0．05）。10mmHg组、12mmHg组、15mmHg组患者术后肠麻痹发生比例分别为4／19、3／19、4／17，肠蠕动恢复时间分别为（37±25）h、（26±16）h、（33±12）h，首次肛门排气或排便时间分别为31．3h（16．8h，45．6h）、40．8h（20．9h，64．5h）、31．9h（20．8h，51．0h），耐受半流质饮食时间分别为142．3h（118．9h，144．9h）、137．4h（118．7h，143．4h）、139．5h�Objective To investigate the effect of elevated CO2 intra-abdominal pressure on acute gastro- intestinal injury （AGI） during laparoscopic colorectal surgery. Methods The clinical data of 66 patients who underwent laparoscopic colorectal surgery at the Ruijin Hospital of Shanghai Jiaotong University School of Medicine from January 2014 to June 2014 were prospectively analyzed. A double blind, randomized, controlled study was performed in the 66 patients who were allocated into the 10 mmHg group （ 1 mmHg = 0. 133 kPa） , 12 mmHg group and 15 mmHg group based on a random number table and setting value of intraoperative CO2 intra-abdominal pressure （10 mmHg, 12 mmHg and 15 mmHg）. The main observation indicators such as intraoperative conditions and postoperative recovery were recorded and the levels of serum IL-6 and TNF-α were detected. Measurement data with normal distribution were presented as x ± s, and comparison among groups was analyzed using the one- way ANOVA. Non-normal distribution data were described as M （Qn） and analyzed by the nonparametric test, count data were presented as the frequency and percentage, and comparison among groups was analyzed using the chi-square test. Results Sixty-six patients were screened for eligibility, and were allocated into the 10 mmHg group, 12mmHg group and 15mmHg group （22 patients in each group） , and 11 patients dropped out of the study （3 in the 10 mmHg group, 3 in the 12 mmHg group and 5 in the 15 mmHg group）. The number of patients with nasogastric tube removal within postoperative hour 6 in the 3 groups were 19, 18 and 14, with no significant difference among the 3 groups （X： = 3.55, P 〉 0.05）. There were 0, 1 and 2 patients in the 3 groups complicated with postoperative early abdominal complications without AGI, showing no significant difference among the 3 groups （X^2=5.82, P 〉 O. 05 ）, and they were cured by the conservative treatment without reoperation in the short term. Fifteen patients had AGI, including 8 with grade I o

关 键 词：急性胃肠损伤 腹腔内压力 术后恢复 炎症介质 腹腔镜检查 

分 类 号：R735.34[医药卫生—肿瘤]