腹腔镜结直肠癌手术中CO2气腹压力对急性胃肠损伤的影响

摘要

Objective To investigate the effect of CO2 pneumoperitoneum pressure on acute gastrointestinal injury (AGI) in laparoscopic colorectal cancer resection.Methods 119 patients with colorectal cancer undergoing laparoscopic radical resection were selected from October 2010 to September 2016.According to the random number table method,they were divided into 3 groups.The intraoperative pneumoperitoneum pressure was set to 10mmHg,12mmHg and 15mmHg in group A,B,C respectively.Comparison of the three groups was carried out about intraoperative conditions,postoperative recoveries,plasma D-lactate levels and postoperative complications.Results There was no significant difference in the duration of operation,the amount of intraoperative blood loss,the duration of pneumoperitoneum,and postoperative first exhaust/defecation time among the three groups (P ＞ 0.05).The levels of D-lactic acid in group C were significantly higher than that of group A and B 2 hours and 24 hours after operation (P ＜ 0.05).There was no significant difference among the three groups in the incidence of postoperative complications (chylous leakage,anastomotic fistula,acute gastrointestinal injury,postoperative hemorrhage and intestinal paralysis).Conclusion There is no significant effect of CO2 pneumoperitoneum pressure on the appearance of acute gastrointestinal injury in the range of 10 ～ 15 mmHg during laparoscopic colorectal cancer resection.%目的 探讨腹腔镜下结直肠癌手术中CO2气腹压力对急性胃肠损伤(acute gastrointestinal injury,AGI)的影响. 方法 根据入选标准选取我院自2010年10月至2016年9月收治的119例行腹腔镜下结直肠癌根治性切除术的患者,按照随机数字表法分为A、B、C三组,A组40例,术中气腹压力设为10 mmHg;B组40例,术中气腹压力设为12 mmHg;C组39例,术中气腹压力设为15 mmHg.比较三组患者术中情况、术后各项指标恢复情况、血浆D--酸水平及术后并发症情况. 结果 三组患者手术持续时间、术中出血量及气腹持续时间比较差异无统计学意义(P＞0.05);三组患者术后各项指标恢复情况(术后首次排气/排便时间、首次肠鸣音时间、术后首次进食时间)差异无统计学意义(P＞0.05);血浆D-乳酸水平在术前、术后48 h三组比较差异无统计学意义(P＞0.05);术后2h、24h时C组血浆D-乳酸水平显著高于A、B两组,差异具有统计学意义(P＜0.05);三组术后并发症发生率(乳糜漏、吻合口瘘、急性胃肠损伤、术后出血、肠麻痹)差异无统计学意义(P＞0.05). 结论 在腹腔镜结直肠癌手术中CO2气腹压力在10 ～ 15 mmHg范围内对急性胃肠损伤的出现无明显影响,但尽量应控制在15 mmHg以下.