超低气腹压辅助悬吊在腹腔镜结肠全系膜切除术(CME)中的应用
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摘要
目的:探讨超低气腹压辅助悬吊在腹腔镜结肠全系膜切除术(CME)中应用的可行性和临床价值。方法:选择2016年9月1日至2018年9月1日在我院接受腹腔镜CME手术的50例结肠癌患者,将其随机分为正常气腹压力组(Ⅰ组)与超低气腹压组(Ⅱ组),每组各25例。观察和比较两组患者的术中各时间点血流动力学和血气分析指标、术中出血量、术后排气时间、术后住院时间、术后并发症发生情况以及手术切除范围和标本质量。结果:两组患者气腹前平均动脉压(mean arterial pressure, MAP)、心率(heart rate, HR)、动脉血二氧化碳分压(partial pressure of carbon dioxide in artery, PaCO_2)、血氧分压(partial pressure of oxygen, PaO2)比较差异均无统计学意义(P>0.05);两组患者平卧位气腹后15、30、60、120 min时MAP、HR、PaCO_2逐渐升高,PaO2逐渐下降,其中气腹后30、60、120 min时与气腹前比较差异均具有统计学意义(P<0.05);气腹结束时,两组患者的MAP、HR、PaCO_2均下降,PaO2升高,Ⅱ组患者基本恢复气腹前水平,Ⅰ组患者与气腹前比较差异均具有统计学意义(P<0.05)。Ⅰ组患者气腹30、60、120 min时MAP、HR、PaCO_2均显著高于Ⅱ组(P<0.05),而PaO2显著低于Ⅱ组(P<0.05)。Ⅱ组术中出血量、排气时间及住院时间均明显低于Ⅰ组(P<0.05),而Ⅰ组术后并发症发生率明显高于Ⅱ组(P<0.05)。两组患者切除平面、肿瘤距切缘的距离和巴结清扫数目比较差异无统计学意义(P>0.05)。结论:超低气腹压辅助悬吊在腹腔镜结肠全系膜切除术(CME)中的应用具有可行性,对患者心肺功能的影响较小,且正常气腹压力CME疗效基本相同,可成为老年患者尤其是伴有心肺疾患者的一种选择。
Objective: To explore the application of low-pressure pneumoperitoneum aided suspended laparoscopic cholecystectomy for the CME. Methods: From September 1 2016 to September 1 2018, 50 cases of colon cancer patients treated by CME were selected and randomly divided into two groups: normal pneumoperitoneum pressure group(groupⅠ) and low pressure pneumoperitoneum group(group Ⅱ), with 25 cases in each group. The hemodynamics and blood gas analysis index, intraoperative blood loss, postoperative exhaust time, postoperative hospital stay, postoperative complications and surgical removal of the range and quality of specimens of two groups were compared at each time point. Results: There was no statistically significant difference in the MAP, HR,PaCO2, and PaO_2 between the two groups(P <0.05). At 15, 30, 60, 120 min after pneumoperitoneum, the MAP, HR, PaCO2 of both groups gradually rised, PaO_2 gradually declined, including 30, 60, 120 min after pneumoperitoneum with comparison before pneumoperitoneum(P<0.05). At the end of the pneumoperitoneum, both groups showed a decrease in the MAP, HR, PaCO2, as well as an increase in the PaO_2. The resumption of pneumoperitoneum of group Ⅱ returned to the basic level, while groupⅠ had statistically significant difference(P< 0.05). The MAP, HR and PaCO2 were significantly higher in groupⅠ than those in group Ⅱ(P < 0.05), while PaO_2 was significantly lower than that of group Ⅱ(P<0.05). The amount of bleeding, exhaust time and length of hospitalization in group Ⅱ were significantly lower than those in groupⅠ(P<0.05), while the incidence of postoperative complications in group Ⅱ was significantly lower than that in groupⅠ(P<0.05). There was no statistically significant difference in the removal of the plane, the distance between the tumor margins and the number of the obturator clearance between the two groups of patients(P <0.05). Conclusions: Low pneumoperitoneum pressure auxiliary suspension is feasible for CME with less effect on the cardiopulmonary function, and the curative effect was basically equal to the normal pneumoperitoneum pressure CME, which is a choice especially for the elderly patients with cardiopulmonary disease.
Objective: To explore the application of low-pressure pneumoperitoneum aided suspended laparoscopic cholecystectomy for the CME. Methods: From September 1 2016 to September 1 2018, 50 cases of colon cancer patients treated by CME were selected and randomly divided into two groups: normal pneumoperitoneum pressure group(groupⅠ) and low pressure pneumoperitoneum group(group Ⅱ), with 25 cases in each group. The hemodynamics and blood gas analysis index, intraoperative blood loss, postoperative exhaust time, postoperative hospital stay, postoperative complications and surgical removal of the range and quality of specimens of two groups were compared at each time point. Results: There was no statistically significant difference in the MAP, HR,PaCO2, and PaO_2 between the two groups(P <0.05). At 15, 30, 60, 120 min after pneumoperitoneum, the MAP, HR, PaCO2 of both groups gradually rised, PaO_2 gradually declined, including 30, 60, 120 min after pneumoperitoneum with comparison before pneumoperitoneum(P<0.05). At the end of the pneumoperitoneum, both groups showed a decrease in the MAP, HR, PaCO2, as well as an increase in the PaO_2. The resumption of pneumoperitoneum of group Ⅱ returned to the basic level, while groupⅠ had statistically significant difference(P< 0.05). The MAP, HR and PaCO2 were significantly higher in groupⅠ than those in group Ⅱ(P < 0.05), while PaO_2 was significantly lower than that of group Ⅱ(P<0.05). The amount of bleeding, exhaust time and length of hospitalization in group Ⅱ were significantly lower than those in groupⅠ(P<0.05), while the incidence of postoperative complications in group Ⅱ was significantly lower than that in groupⅠ(P<0.05). There was no statistically significant difference in the removal of the plane, the distance between the tumor margins and the number of the obturator clearance between the two groups of patients(P <0.05). Conclusions: Low pneumoperitoneum pressure auxiliary suspension is feasible for CME with less effect on the cardiopulmonary function, and the curative effect was basically equal to the normal pneumoperitoneum pressure CME, which is a choice especially for the elderly patients with cardiopulmonary disease.
引文
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[18]Brenton R.Franklin,Michael P.Mc Nally.Laparoscopy for colon cancer[J].Clinics in Colon and Rectal Surgery,2017,30(02):099-103
[19]俞晓峰.老年结肠癌行腹腔镜切除术的疗效观察[J].现代消化及介入诊疗,2016,21(3):421-423
[20]李卫平,张江南.无瘤操作技术在胃肠道肿瘤手术中的应用[J].实用医学杂志,2014,30(24):4053-4054
[21]胥润.腹腔镜下直肠癌根治术与开腹直肠癌根治术近期疗效比较[J].实用医院临床杂志,2016,13(1):071-073
[22]李大为,徐磊,王海青,等.腹壁悬吊腹腔镜手术治疗结直肠癌的疗效和预后观察[J].现代消化及介入诊疗,2016,21(6):858-860
[23]唐自元,江勃年,胡英斌,等.Trocar悬吊式免气腹腹腔镜下行直肠癌根治术的体会[J].中国现代手术学杂志,2014,18(5):338
[2]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China[J].CACancer J Clin,2016,66(2):115-132
[3]Hohenberger W,Weber K,Matzel K,et al.Standardized surgery for colonic cancer:complete mesocolic excision and central ligationtechnical notes and outcome[J].Colorectal Dis,2009,11(4):354-364
[4]刘扬.不同气腹压对腹腔镜直肠癌根治术患者术后恢复的影响研究[J].结直肠肛门外科,2018,24(2):133-137
[5]李会清,高宝峰,张增臻,等.腹腔镜胆囊切除术中不同气腹压力对全身麻醉患者呼吸循环功能的影响[J].山东医药,2015,55(33):76-77
[6]韦维,黄许森,岑小宁,等.腹腔镜直肠癌手术中CO2气腹压力对急性胃肠损伤的影响[J].中国现代手术学杂志,2017,21(2):4-8
[7]Yamamoto S,Inomata M,Katayama H,et al.Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3dissection for stage II/III colon cancer:Japan Clinical Oncology Group Study JCOG 0404[J].Ann Surg,2014,260(1):23-30
[8]王朔,于流洋,陈凯,等.上腹部腹腔镜手术中CO2气腹及腹内压改变对脑血流的影响[J].临床麻醉学杂志,2015,31(9):918-919
[9]Bonjer HJ,Deijen CL,Abis GA,et al.A randomized trial of laparoscopic versus open surgery for rectal cancer[J].N Engl J Med,2015,372(14):1324-1332
[10]王建球,周海华,史佩东,等.免气腹及气腹腹腔镜胆囊切除术的对比研究[J].肝胆外科杂志,2014,22(3):184-187
[11]Pascual M,Salvans S,Pera M.Laparoscopic colorectal surgery:Current status and implementation of the latest technological innovations[J].World J Gastroenterol,2016,22(2):704-717
[12]West NP,Morris EJ,Rotimi O,et al.Pathology grading of colon cancer surgical resection and its association with survival:a retrospective observational study[J].Lancet Oncol,2008,9(9):857-865
[13]康清杰,向征.结肠癌筛查和诊疗的研究进展[J].重庆医学,201544(28):4001-4003
[14]曹广,伍冀湘.腹壁悬吊式与二氧化碳气腹腹腔镜手术对大肠肿瘤患者血浆黏附分子的影响[J].中国医药,2015,10(1):22-26
[15]Siani LM,Pulica C.Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer:long-term oncologic outcome between mesocolic and non-mesocolic planes of surgery[J].Scand J Surg,2015,104(4):219-226
[16]郭润生,闫金龙,谢津璧,等.低气腹压辅助悬吊式腹腔镜在老年胆囊切除术中的应用研究[J].中国微创外科杂志,2018,18(6):481-485
[17]Galizia G,Lieto E,De Vita F,et al.Is complete mesocolic excision with central vascular ligation safe and effective in the surgical treatment of right-sided colon cancers?A prospective study[J].Int JColorectal Dis,2014,29(1):89-97
[18]Brenton R.Franklin,Michael P.Mc Nally.Laparoscopy for colon cancer[J].Clinics in Colon and Rectal Surgery,2017,30(02):099-103
[19]俞晓峰.老年结肠癌行腹腔镜切除术的疗效观察[J].现代消化及介入诊疗,2016,21(3):421-423
[20]李卫平,张江南.无瘤操作技术在胃肠道肿瘤手术中的应用[J].实用医学杂志,2014,30(24):4053-4054
[21]胥润.腹腔镜下直肠癌根治术与开腹直肠癌根治术近期疗效比较[J].实用医院临床杂志,2016,13(1):071-073
[22]李大为,徐磊,王海青,等.腹壁悬吊腹腔镜手术治疗结直肠癌的疗效和预后观察[J].现代消化及介入诊疗,2016,21(6):858-860
[23]唐自元,江勃年,胡英斌,等.Trocar悬吊式免气腹腹腔镜下行直肠癌根治术的体会[J].中国现代手术学杂志,2014,18(5):338