在有限的腹腔镜肝切除术中，肝内压力升高和肝组织血流减少可预防气体栓塞。
Elevated intrahepatic pressures and decreased hepatic tissue blood flow prevent gas embolus during limited laparoscopic liver resections.
作者信息
Ricciardi R, Anwaruddin S, Schaffer B K, Quarfordt S H, Donohue S E, Wheeler S M, Gallagher K A, Callery M P, Litwin D E, Meyers W C
机构信息
Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA.
出版信息
Surg Endosc. 2001 Jul;15(7):729-33. doi: 10.1007/s004640000235. Epub 2001 Apr 12.
BACKGROUND
As new techniques are emerging for laparoscopic liver resections, concerns have been raised about the development of gas embolus related to the CO(2) pneumoperitoneum. We hypothesized that elevated intrahepatic vascular pressures and decreased hepatic tissue blood flow (LQB) would prevent gas embolus during laparoscopic liver resections under conventional pneumoperitoneum.
METHODS
Intrahepatic vascular pressures and LQB were measured in nine pigs with varying CO(2) pneumoperitoneum. Gas embolus was determined after hepatic incision by monitoring pulmonary arterial pressure (PAP), hepatic venous PCO(2), systemic blood pressure (SBP), and suprahepatic vena cava ultrasound.
RESULTS
As the pneumoperitoneum was increased from 0 to 15 mmHg, intrahepatic vascular pressures increased significantly (p < 0.05), while LQB decreased significantly (p < 0.05). A 2.0-cm hepatic incision at 4, 8, 15, and 20mmHg produced no ultrasound evidence of gas embolus and no changes in PAP, SBP, or hepatic venous PCO(2) (p = NS).
CONCLUSION
These data suggest that the risk of significant embolus under conventional pneumoperitoneum is minimal during laparoscopic liver resections.
背景
随着腹腔镜肝切除术新技术的出现，人们对与二氧化碳气腹相关的气体栓塞的发生提出了担忧。我们假设在传统气腹下进行腹腔镜肝切除术中，肝内血管压力升高和肝组织血流（LQB）减少可预防气体栓塞。
方法
在9只施加不同二氧化碳气腹的猪身上测量肝内血管压力和LQB。在肝切开后，通过监测肺动脉压（PAP）、肝静脉PCO₂、体循环血压（SBP）和肝上腔静脉超声来确定气体栓塞。
结果
当气腹压力从0增加到15 mmHg时，肝内血管压力显著升高（p < 0.05），而LQB显著降低（p < 0.05）。在4、8、15和20 mmHg气腹压力下进行2.0 cm的肝切口，未发现气体栓塞的超声证据，PAP、SBP或肝静脉PCO₂也无变化（p = 无显著性差异）。
结论
这些数据表明，在腹腔镜肝切除术中，传统气腹下发生严重栓塞的风险极小。
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