空气与二氧化碳气腹腹腔镜胆囊切除术的比较

摘要

Objective To compare the efficacy of air pneumoperitoneum with CO 2 pneumoperitoneum during laparoscopic cholecystectomy ( LC) , and to explore the application value of air pneumoperitoneum LC . Methods From July 2013 to October 2013, 109 patients with benign gallbladder disease were assigned to air group (n=53) or CO2 group (n=56) based on the date of operation.All the instruments used in the air group were exactly the same as the CO 2 group except for the gas to build pneumoperitoneum .The complications , pain reaction , postoperative hospital stay , and total hospital cost were compared between the two groups . Results All the procedures were completed successfully in both the groups without conversion to open surgery or serious complications.No patient in air group was converted to CO 2 pneumoperitoneum .Compared with the CO2 group, the air group had less incidence of postoperative shoulder pain (χ2 =4.097,P=0.043), less incidence of postoperative nausea and vomiting (χ2 =4.584,P=0.032), lower visual analogue scale scores (t=-3.568,P=0.000), shorter postoperative exhaust time (Z=-4.287,P=0.000), shorter postoperative hospital stay(t=-2.312,P=0.023)and less hospital cost(t=-3.854,P=0.000). Conclusions Air pneumoperitoneum LC is safe and feasible . It both reduces emission of CO 2 and relieves postoperative complications of CO 2 pneumoperitoneum LC .%目的：比较空气与CO2气腹腹腔镜胆囊切除术（ laparoscopic cholecystectomy ， LC）的临床效果，探讨空气膨腹介质下LC的临床应用价值。方法2013年7～10月109例胆囊良性疾病按本科手术日分为2组，分别施行空气气腹或CO2气腹LC，前者除使用空气气腹外，余均使用常规的腹腔镜手术设备和操作器械，比较2组手术并发症、疼痛反应、术后住院时间、总住院费用等。结果2组均顺利完成LC，无中转开腹、严重并发症发生。空气组无一例中转CO2气腹手术，与CO2组比较，空气组术后肩痛发生率低（χ2＝4．097，P＝0．043）、恶心呕吐发生率低（χ2＝4．584，P＝0．032）、视觉模拟评分低（ t＝-3．568，P＝0．000）、术后排气时间短（Z＝-4．287，P＝0．000）、术后住院时间短（t＝-2．312，P＝0．023）、住院费用低（t＝-3．854，P＝0．000）。结论空气气腹LC安全可行，简易价廉，减少CO2排放，减轻CO2气腹术后并发症。