不同气腹压力下完全腹膜外腹股沟疝修补术气腹相关并发症的对比研究  

A comparative study of complications related to CO2 pneumoperitoneum in totally extraperitoneal inguinal hernia repair under different pneumoperitoneum pressure

作　　者：王廷峰 倪燕婷 吴德俊 王伟 谢鹏程 孙磊磊 徐明 WANG Ting-feng;NI Yan-ting;WU De-jun(Department of General Surgery,Fudan University Pudong Medical Center,Shanghai 201399,China)

机构地区：[1]上海市浦东医院暨复旦大学附属浦东医院普通外科,上海201399 [2]上海市浦东医院暨复旦大学附属浦东医院麻醉科

出　　处：《腹腔镜外科杂志》2020年第12期903-907,共5页Journal of Laparoscopic Surgery

基　　金：上海市浦东新区卫生系统特色专病建设资助(PWZzb2017-15)。

摘　　要：目的:比较不同CO2气腹压力下腹腔镜完全腹膜外腹股沟疝修补术后气腹相关并发症的发生情况。方法:前瞻性选取2017年10月至2019年10月收治的120例行腹腔镜完全腹膜外腹股沟疝修补术的成年单侧初发腹股沟疝患者,按气腹压力分为低压组(L组,8 mmHg)、标准压力1组(S1组、12 mmHg)、标准压力2组(S2组,14 mmHg),每组40例。比较不同时点血PaCO2、丙二醛、谷胱甘肽/氧化型谷胱甘肽水平及皮下气肿、阴囊气肿、手术时间、出血量、住院时间等指标。结果:与L组、S1组相比,S2组术后PaCO2、皮下气肿发生率增加(P<0.0001),丙二醛、谷胱甘肽/氧化型谷胱甘肽水平变化明显(P<0.0001);L组手术时间稍长于S1组、S2组(P<0.01)。3组术中出血量、住院时间差异无统计学意义。结论:在12 mmHg CO2气腹压力下可建立足够的腹膜外空间,并不增加腹股沟疝修补术的操作难度,而且可有效控制气腹相关并发症的发生。Objective:To compare the incidence of pneumoperitoneum related complications after laparoscopic totally extraperitoneal(TEP)inguinal hernia repair under different CO2 pneumoperitoneum pressure.Methods:From Oct.2017 to Oct.2019,120 adult patients with unilateral primary inguinal hernia treated by TEP were randomly divided into 3 groups,40 cases in each group.According to different pneumoperitoneum pressure,the patients were divided into low pressure(8 mmHg)group:L,standard pressure 1(12 mmHg)group:S1 and standard pressure 2(14 mmHg)group:S2.The levels of PaCO2,malonaldehyde,glutathione/glutathione oxidized,subcutaneous emphysema,scrotal emphysema,operation time,blood loss and hospital stay were compared at different time points.Results:The level of PaCO2 and incidence of subcutaneous emphysema significantly increased in S2 group than those in L and S1 group(P<0.0001),and the levels of malonaldehyde and glutathione/glutathione oxidized changed significantly in S2 group(P<0.0001),while the operation time in group L was slightly longer than that in group S1 and S2(P<0.01).There was no significant difference in the amount of bleeding and the length of hospitalization among the three groups.Conclusions:Enough extraperitoneal space can be established at 12 mmHg CO2 pneumoperitoneum pressure,which does not increase the operation difficulty of inguinal hernia repair,and can effectively control the occurrence of pneumoperitoneum related complications.

关 键 词：疝 腹股沟 疝修补术 完全腹膜外 腹腔镜检查 气腹压力 并发症 

分 类 号：R656.21[医药卫生—外科学]