无气腹腔镜与CO_2气腹腹腔镜对精索静脉曲张患者围手术期的影响  

Peri-operative Influences of gasless and CO_2 pneumoperitoneum laparoscopy no patients with varicocele

作　　者：吴宇[1] 刘建民[1] 张家俊[1] 高五岳 刘贝贝[1] 

机构地区：[1]蚌埠医学院第一附属医院泌尿外科,安徽蚌埠233004

出　　处：《中华全科医学》2016年第2期200-202,共3页Chinese Journal of General Practice

基　　金：蚌埠医学院第一附属医院2014年高新技术项目(蚌医一附院[2014]35号)

摘　　要：目的总结分析无气腹腔镜与CO_2气腹腹腔镜技术治疗精索静脉曲张的方法,对比分析不同方法血流动力学变化,患者围手术期的不同变化。方法对40例精索静脉曲张患者(均为左侧),按照入院先后顺序随机分为无气腹腔镜组(实验组)及CO_2气腹腹腔镜组(对照组),每组20例患者。均行单孔腹腔镜下行精索内静脉高位结扎术。比较2组患者的围手术期变化,包括检测2组患者麻醉开始前(T1)、悬架或气腹建立后30 min(T2)和悬架或气腹撤除后10 min(T3)3个时间点的平均动脉压、中心静脉压、心率、血氧饱和度、p H值和动脉血CO_2分压(Pa CO_2)水平,观察患者术后变化。结果 40例患者均手术成功,实验组术后肠鸣音恢复时间短、恶心呕吐发生率低,与对照组比较,差异有统计学意义(P<0.05),在T2时间点上,实验组中心静脉压、Pa CO_2水平均低于对照组,2组对比差异有统计学意义(P<0.05)。结论无气腹腔镜技术治疗精索静脉曲张是更安全可行的,对维持患者手术期间生命体征的平稳有积极作用,同时具有手术切口小、恢复快、术后瘢痕隐蔽等优点。CO_2气腹腹腔镜组术后肠鸣音恢复时间较长,恶心呕吐发生率较高,无气腹腔镜手术没有CO_2对患者的血流动力学及机体内环境的影响。Objective To analyze the treatment method of gasless laparoscopic and CO： pneumoperitoneum laparoscopic varicocele, compare the of hemodynamic changes and perioperative variations of different methods. Methods The 40 cases of varicocele patients （ all the left） were divided into gasless group and CO2 pneumoperitoneum group according to the order of admission time randomly, and there were 20 patients in each group. All patients were given High-level ligation of spermatic vein;Comparison of per-operative changes were done between gasless group and CO2 pneumoperitoneum laparo- scopic group,including detection of two groups of patients before the start of anesthesia（T1 ）, suspension or gas after the abdomen after the establishment of 30 rain （T2） and the suspension or removal of pneumoperitoneum 10 min （T3） and mean arterial pressure of three time-point, central venous pressure, heart rate, oxygen saturation, PH value, arterial pressure of CO2 （ PaCO2 ） level, and post-operative changes. Results Surgery of 40 patients were successful, the time of bowel function recovery, the incidence of nausea and vomiting between the two groups were statistically significant differences （ P 〈 0.05 ） , and the central venous pressure in the experimental group, PaCO2 levels were points in time T2 the difference were statistically significant differences （ P 〈 0.05 ）. Conclusions Gasless laparoscopic technique is a safe and feasible method for treatment of varicocele, and easy to maintain stabilization of patient＇ s vital signs during operative time, and also have advantages of small incision, quick recovery, scar hidden. CO2 pneumoperitoneum group was gurgling sound reeove-y lime is longer, higher incidence of nausea and vomiting, no hemodynamies and internal environment of the patient＇ s blood vessel CO2 gasless laparoscopie surgery.

关 键 词：无气腹腔镜 精索静脉曲张 高位结扎术 围手术期 

分 类 号：R697.24[医药卫生—泌尿科学] R699.8[医药卫生—外科学]