Mimica Z, Biocić M, Bacić A, Banović I, Tocilj J, Radonić V, Ilić N, Petricević A
Department of Surgery, Split University Hospital, Split, Croatia.
Respiration. 2000;67(2):153-8. doi: 10.1159/000029479.
The fact that pulmonary complications occur in 20-60% of the patients subjected to abdominal operations clearly indicates that the lungs are the most endangered organ during the postoperative period.
The aim of this study was to demonstrate the impact of cholecystectomy on postoperative respiratory disturbances by comparing the laparotomic cholecystectomy with laparoscopic gallbladder removal.
A hundred cholecystectomized patients were included in the prospective randomized clinical trial. Half of the patients were operated on by the laparotomic procedure, whereas the other half underwent laparoscopic cholecystectomy. Spirometric parameters, arterial blood gases, and acid-base balance were determined before the operation, and at 6, 24, 72 and 144 h postoperatively. Abdominal distension was assessed by auscultating intestinal peristaltics, abdominal circumference measurement, and time interval to restitution of defecation.
Six hours postoperatively, the values of ventilation parameters decreased on average by 40-50% from the baseline preoperative values in both groups of patients. The group of patients submitted to laparotomic cholecystectomy had significantly lower spirometric values and slower recovery of the ventilation parameters than the laparoscopic cholecystectomy group. Abdominal circumference was significantly greater and the time needed for restitution of peristaltics and defecation was significantly longer in the laparotomic cholecystectomy group compared to the group of laparoscopic cholecystectomy.
Statistically significant impairments including hypoxia, hypocapnia and hyperventilation were observed in the patients submitted to laparotomic cholecystectomy, indicating the presence of objective respiratory risk, especially in elderly patients and patients with obstructive pulmonary diseases or cardiac insufficiency.
接受腹部手术的患者中20%-60%会出现肺部并发症，这一事实清楚地表明肺部是术后最易受影响的器官。
本研究旨在通过比较开腹胆囊切除术和腹腔镜胆囊切除术，来证明胆囊切除术对术后呼吸功能障碍的影响。
一百例接受胆囊切除术的患者纳入前瞻性随机临床试验。一半患者接受开腹手术，另一半接受腹腔镜胆囊切除术。在手术前、术后6小时、24小时、72小时和144小时测定肺功能参数、动脉血气和酸碱平衡。通过听诊肠道蠕动、测量腹围以及排便恢复的时间间隔来评估腹胀情况。
术后6小时，两组患者的通气参数值平均较术前基线值下降了40%-50%。接受开腹胆囊切除术的患者组肺功能参数值显著低于腹腔镜胆囊切除术组，且通气参数恢复较慢。与腹腔镜胆囊切除术组相比，开腹胆囊切除术组的腹围明显更大，恢复蠕动和排便所需的时间明显更长。
接受开腹胆囊切除术的患者出现了包括低氧血症、低碳酸血症和通气过度等具有统计学意义的损伤，表明存在客观的呼吸风险，尤其是在老年患者以及患有阻塞性肺疾病或心脏功能不全的患者中。
