标准气腹压腹腔镜手术与低气腹压辅助悬吊式腹腔镜手术治疗发病48 h内急性胆囊炎疗效研究  

Efficacy of standard pneumoperitoneal pressure laparoscopic surgery and low pneumoperitoneal pressure assisted suspension laparoscopic surgery on acute cholecystitis within 48 hours of onset

作　　者：戚谢 马达 张艮龙 许程伟 张琦[3] QI Xie;MA Da;ZHANG Gen-long;XU Cheng-wei;ZHANG Qi(Department of Emergency Surgery,Suzhou Hospital Affiliated to Anhui Medical University,Suzhou 234000,China)

机构地区：[1]安徽医科大学附属宿州医院(宿州市立医院)急诊外科,安徽宿州234000 [2]安徽医科大学附属宿州医院(宿州市立医院)普外科,安徽宿州234000 [3]安徽中医药大学第一附属医院普外科,安徽合肥230009

出　　处：《创伤与急危重病医学》2022年第1期20-24,共5页Trauma and Critical Care Medicine

基　　金：2020年度安徽医科大学校科研基金(2020xkj264)。

摘　　要：目的探讨标准气腹压腹腔镜手术与低气腹压辅助悬吊式腹腔镜手术治疗发病48 h内急性胆囊炎患者的临床疗效。方法选取自2020年8月至2021年7月安徽医科大学附属宿州医院收治的发病48 h内行手术治疗的急性胆囊炎患者80例,根据术式将患者分为标准气腹压组(n=41)与低气腹压组(n=39)。标准气腹压组患者行标准气腹压腹腔镜手术治疗,低气腹压组患者行低气腹压辅助悬吊式腹腔镜手术治疗。记录并比较两组患者手术时间、肛门排气时间、下床活动时间、住院时间,术前、术后1 d视觉模拟疼痛评分(VAS)、简易智能精神状态量表(MMSE)评分,术前、术后2 h二胺氧化酶(DAO)、D-乳酸,气腹前、气腹后20 min及气腹放尽后5 min收缩压(SBP)、心率(HR)、气道压力,以及术后并发症发生情况。结果两组患者手术时间、肛门排气时间、下床活动时间及住院时间比较,差异无统计学意义(P>0.05)。两组患者术前VAS评分、MMSE评分比较,差异无统计学意义(P>0.05)。术后1 d,两组患者VAS评分低于术前,且低气腹压组低于标准气腹压组;两组患者MMSE评分均较术前降低,但低气腹压组高于标准气腹压组,差异有统计学意义(P<0.05)。气腹前,两组患者SBP、HR、气道压力较气腹前比较,差异无统计学意义(P>0.05)。气腹后20 min,标准气腹压组患者SBP、HR、气道压力较气腹前升高;低气腹压组SBP、HR较气腹前降低,气道压力较气腹前升高,但均显著低于标准气腹压组,差异有统计学意义(P<0.05)。气腹放尽后5 min,标准气腹压组SBP、HR较气腹后20 min降低,低气腹压组SBP、HR较气腹后20 min升高,差异有统计学意义(P<0.05);但两组间SBP、HR比较,差异无统计学意义(P>0.05)。气腹放尽后5 min,两组患者气道压力均较气腹后20 min降低,且低气腹压组低于标准气腹压组,差异有统计学意义(P<0.05)。两组患者术前、术后2 h的DAO、D-乳酸水平比较,差�Objective To investigate the clinical efficacy of standard pneumoperitoneal pressure laparoscopic surgery and low pneumoperitoneal pressure assisted suspension laparoscopic surgery on acute cholecystitis within 48 hours of onset.Methods A total of 80 acute cholecystitis patients admitted to Suzhou Hospital Affiliated to Anhui Medical University who were received surgical treatment within 48 hours of onset were selected from August 2020 to July 2021.According to the operation method,the patients were divided into standard pneumoperitoneum pressure group(n=41)and low pneumoperitoneal pressure group(n=39).The patients in the standard pneumoperitoneal pressure group were treated with standard pneumoperitoneal pressure laparoscopic surgery,and the patients in the low pneumoperitoneal pressure group were treated with low pneumoperitoneal pressure assisted suspension laparoscopic surgery.The operation time,anal exhaust time,ambulation time,hospitalization time were recorded and compared between the two groups.The visual analogue score(VAS)and mini-mental state examination(MMSE)score before the operation and 1 day after the operation,diamine oxidase(DAO)and D-lactic acid before and 2 hours after the operation were recorded and compared between the two groups.The systolic blood pressure(SBP),heart rate(HR),airway pressure before pneumoperitoneum,20 minutes after pneumoperitoneum,and 5 minutes after exhaustion of pneumoperitoneum,and postoperative complications were recorded and compared between the two groups.Results There was no significant difference in operation time,anal exhaust time,ambulation time,hospitalization time between the two groups(P>0.05).Before the operation,there was no significant difference in VAS score,MMSE score between the two groups(P>0.05).One day after the operation,the VAS score of the two groups was lower than before,and the VAS score of low pneumoperitoneal pressure group was significantly lower than that of standard pneumoperitoneum pressure group(P<0.05).One day after the operation,the MMSE

关 键 词：急性胆囊炎 低气腹压 标准气腹压 悬吊式腹腔镜手术 疗效 

分 类 号：R657.41[医药卫生—外科学]