不同腹腔镜腹股沟疝修补术中二氧化碳气腹对酸碱平衡影响随机对照研究  

Prospective randomized controlled study of the effect of carbon dioxide pneumoperitoneum on acid-base balance during different laparoscopic inguinal hernia repair

作　　者：刘雨辰[1] 朱熠林[1] 陈杰[1] 王明刚[1] LIU Yu-chen;ZHU Yi-lin;CHEN Jie;WANG Ming-gang(Department of Hernia and Abdominal Wall Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院疝和腹壁外科,北京100043

出　　处：《中国实用外科杂志》2021年第4期415-418,共4页Chinese Journal of Practical Surgery

基　　金：国家卫生健康委医院管理研究所“医疗质量循证管理持续改进研究项目”(No.YLZLXZ-2020-006)。

摘　　要：目的对比CO_(2)气腹在腹腔镜经腹腹膜前修补手术(TAPP)和腹腔镜完全腹膜外修补手术(TEP)中对酸碱平衡代谢的影响结果。方法收集2019-06-01至2019-11-30首都医科大学附属北京朝阳医院疝和腹壁外科日间病房收治的共100例原发性腹股沟疝病人的临床资料。将全部病人按随机数字表分为TAPP组和TEP组,各50例。通过对比手术前后血气分析和术中动态经皮CO_(2)(TcCO_(2))变化,分析病人的酸碱平衡代谢情况。随访并比较两组病人术后并发症情况。结果TEP组病人的手术时间较TAPP组更短(P<0.01),而在CO_(2)代谢方面和酸碱平衡方面,TAPP组较TEP组病人差异具有统计学意义,包括PaCO_(2)变化[(7.5±3.4)mmHg vs.(20.4±7.6)mmHg,P<0.01]、TcCO_(2)变化[(8.9±3.6)mmHg vs.(17.4±8.0)mmHg,P<0.01]、TcCO_(2)变化速率[(0.2±0.1)mmHg vs.(1.0±0.6)mmHg,P<0.01]、pH值变化(-0.05±0.28 vs.-0.15±0.76,P<0.01)。两组病人随访中未出现感染、慢性疼痛的病例,TEP组1例复发。两组病人血清肿、术后静息痛、术后活动痛方面差异无统计学意义(P>0.05)。结论TEP和TAPP治疗腹股沟疝效果相近,但TEP在CO_(2)代谢方面劣于TAPP,TEP可能会在更短的时间内造成更严重的CO_(2)蓄积。Objective To compare the effects of CO_(2) pneumoperitoneum on acid-base balance during transabdominal preperitoneal(TAPP)and total extraperitoneal(TEP)procedures for repair of inguinal hernias.Methods The study cohort comprised 100 patients who underwent repair of primary inguinal hernias from 1 June to 30 November 2019 in Beijing Chaoyang Hospital,Capital Medical University.The patients were randomly allocated to TAPP and TEP groups.Their acid-base balance was analyzed by comparing the results of blood gas analysis before and after the operative procedures and dynamic transcutaneous CO_(2)(TcCO_(2))changes during the procedures.In addition,postoperative complications were compared between the two groups after follow-up.Results The operation time was shorter for the TEP than the TAPP group(P<0.01).In terms of CO_(2) metabolism and acid-base balance,the following differences between the two groups were statistically significant:changes in PaCO_(2)[(7.5±3.4)mmHg vs.(20.4±7.6)mmHg,P<0.01],changes in TcCO_(2)[(8.9±3.6)mmHg vs.(17.4±8.0)mmHg,P<0.01],rate of change in TcCO_(2)[(0.2±0.1)mmHg vs.(1.0±0.6)mmHg,P<0.01],and changes in pH(-0.05±0.28 vs.-0.15±0.76,P<0.01).None of all cases of infection or chronic pain in two groups during follow-up occurred,and 1 recurrent case occurred in the TEP group.There was no significant difference in seroma,postoperative resting pain and postoperative activity pain between 2 groups(P>0.05).Conclusion Both of TEP and TAPP procedures have similar results for the treatment of inguinal hernia.Whereas,TAPP and TEP can achieve good results in the treatment of inguinal hernia.Although no serious complication occurred,TEP procedures may cause more serious CO_(2) accumulation and quicker acidosis than TAPP procedures.

关 键 词：腹股沟疝 腹腔镜 二氧化碳 酸碱平衡 代谢 气腹 

分 类 号：R6[医药卫生—外科学]