Vezakis A, Davides D, Gibson J S, Moore M R, Shah H, Larvin M, McMahon M J
Leeds Institute for Minimally Invasive Therapy, Academic Unit of Surgery, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
Surg Endosc. 1999 Sep;13(9):890-3. doi: 10.1007/s004649901127.
Laparoscopic cholecystectomy using low-pressure pneumoperitoneum (8 mmHg) minimizes adverse hemodynamic effects, reduces postoperative pain, and accelerates recovery. Similar claims are made for gasless laparoscopy using abdominal wall lifting. The aim of this study was to compare gasless laparoscopic cholecystectomy to low-pressure cholecystectomy with respect to postoperative pain and recovery.
Thirty-six patients were randomized to low-pressure or gasless laparoscopic cholecystectomy using a subcutaneous lifting system (Laparotenser).
The characteristics of the patients were similar in the two groups. The procedure was completed in all patients in the low-pressure group, but two patients in the gasless group were converted to pneumoperitoneum. There were no significant differences in postoperative pain and analgesic consumption, but patients in the gasless group developed shoulder pain more frequently (50% vs 11%, p < 0.05). Gasless operation took longer to perform (95 vs 72.5 min, p = 0.01).
Gasless and low-pressure laparoscopic cholecystectomy were similar with respect to postoperative pain and recovery. The gasless technique provided inferior exposure and the operation took longer, but the technique may still have value in high-risk patients with cardiorespiratory disease.
使用低压力气腹（8 mmHg）的腹腔镜胆囊切除术可将不良血流动力学影响降至最低，减轻术后疼痛，并加速康复。对于使用腹壁提升技术的免气腹腹腔镜手术也有类似的说法。本研究的目的是比较免气腹腹腔镜胆囊切除术与低压力胆囊切除术在术后疼痛和恢复方面的差异。
36例患者被随机分为接受低压力或免气腹腹腔镜胆囊切除术，后者使用皮下提升系统（Laparotenser）。
两组患者的特征相似。低压力组的所有患者均完成了手术，但免气腹组有2例患者转为气腹手术。术后疼痛和镇痛药物用量无显著差异，但免气腹组患者肩部疼痛的发生率更高（50%对11%，p<0.05）。免气腹手术的操作时间更长（95分钟对72.5分钟，p=0.01）。
免气腹和低压力腹腔镜胆囊切除术在术后疼痛和恢复方面相似。免气腹技术的视野较差，手术时间更长，但该技术在患有心肺疾病的高危患者中可能仍有价值。
