不同Trendelenburg角度对腹腔镜直肠癌根治术中术野暴露及患者心肺功能的影响  

The influence of different Trendelenburg angles on the exposure of laparoscopic radical rectal cancer operation and the cardiopulmonary function of patients

作　　者：孔维杰 李伟[1] 刘彤[1] KONG Wei-jie;LI Wei;LIU Tong(Department of General Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京同仁医院普外科,北京100176

出　　处：《腹腔镜外科杂志》2021年第11期830-834,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨不同Trendelenburg角度对腹腔镜直肠癌根治术(Dixon术)术野暴露及患者心肺功能的影响。方法:收集2018年10月至2020年10月收治的111例行Dixon术患者的临床资料,开展回顾性研究,其中37例Trendelenburg角度为20°(A组),37例Trendelenburg角度为15°(B组),37例为10°(C组)。对比分析3组手术时间、术中出血量、切除标本长度、肿瘤远端切缘长度、术野暴露情况、不良事件发生率,以及建立气腹时、体位调整后10 min、体位调整后20 min心肺功能(中心静脉压、气道峰压、呼气末二氧化碳分压)、血流动力学指标(心率、平均动脉压)及脑功能(搏动指数、阻力指数)。结果:3组手术时间、术中出血量、切除标本长度、肿瘤远端切缘长度差异无统计学意义(P>0.05);A组术野暴露情况优于B组、C组,且B组优于C组(P<0.05);体位调整后10 min、20 min,A组呼吸末二氧化碳分压、气道峰压、中心静脉压、心率高于B组、C组(P<0.05);A组搏动指数、阻力指数大于B组、C组(P<0.05);体位调整后20 min,A组平均动脉压水平高于B组、C组(P<0.05);A组不良事件发生率为13.51%,B组为8.11%,C组为5.41%,3组相比差异无统计学意义(P>0.05)。结论:不同Trendelenburg角度对Dixon术野暴露及患者心肺功能的影响存在明显差异,Trendelenburg角度15°整体应用效果更佳。Objective:To investigate the effects of different Trendelenburg angles on the exposure of the laparoscopic radical rectal cancer surgery(Dixon)and the cardiopulmonary function of patients.Methods:The clinical data of 111 patients who underwent Dixon surgery from Oct.2018 to Oct.2020 were collected to conduct a retrospective study.Among them,37 cases of Trendelenburg angle 20°were defined as group A,while 37 cases of Trendelenburg angle 15°as group B and 37 cases of Trendelenburg angle 10°as group C.The operation time,intraoperative blood loss,length of excised specimen,length of distal tumor margin,surgical field exposure,and incidence of adverse events were comparatively analyzed among the 3 groups,the cardiopulmonary function(central venous pressure,peak airway pressure,partial pressure of end-tidal carbon dioxide),hemodynamic indexes(heart rate,mean arterial pressure)and brain function(pulsatility index,resistance index)at establishing pneumoperitoneum,10 min after adjusting the position,and 20 min after adjusting were compared among the 3 groups.Results:There were no statistically significant differences in the operation time,intraoperative blood loss,length of the excised specimen,and the length of the distal tumor margin among the three groups(P>0.05);The operative field exposure of group A was better than that of groups B and C,and that of group B was better than group C(P<0.05);The partial pressure of end-tidal carbon dioxide,peak airway pressure,central venous pressure and heart rate of group A were higher than those of group B and C at 10 min and 20 min after posture adjustment(P<0.05);The pulsatility index and resistance index of group A were more than those of group B and group C at 10 min and 20 min after posture adjustment(P<0.05);the mean arterial pressure level of group A was higher than group B and group C at 20 min after posture adjustment(P<0.05);The incidence of adverse events in group A was 13.51%,which was 8.11%in group B and 5.41%in group C,and there was no statistically significant diff

关 键 词：直肠肿瘤 腹腔镜检查 Trendelenburg角度 术野暴露 心肺功能 

分 类 号：R657.1[医药卫生—外科学]