Perrakis E, Vezakis A, Velimezis G, Savanis G, Deverakis S, Antoniades J, Sagkana E
Department of Surgery, Western Attica General Hospital, Athens, Greece.
Surg Laparosc Endosc Percutan Tech. 2003 Aug;13(4):245-9. doi: 10.1097/00129689-200308000-00004.
Laparoscopy using carbon dioxide insufflation induces adverse effects in both the cardiovascular and the respiratory function. The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects. However, its effect on tissue trauma and postoperative pain and recovery remains controversial. The aim of this study was to compare tissue trauma, postoperative pain, and recovery in two groups of patients undergoing laparoscopic cholecystectomy, one at insufflation pressure of 8 (LC8) and the other at 15 mm Hg (LC15). Forty patients were randomized, 20 in each group. The characteristics of the patients were similar in the two groups. The procedure was completed in all patients in the LC15 group, but in 2 patients in the LC8 group the pressure was increased to 15 mm Hg to complete the operation. There were no significant differences in postoperative pain scores, analgesic consumption, and the incidence of nausea, vomiting, and shoulder pain between the two groups. C-reactive protein concentrations and white blood cell count rose significantly after surgery, but the increase was similar in the two groups. The median duration of surgery was similar, 23 minutes (range 15-65) in the LC8 group and 25 minutes (range 15-80) in the LC15 group. Using our technique of laparoscopic cholecystectomy, there were no advantages to tissue damage, postoperative pain, and recovery when a low pressure pneumoperitoneum was used.
使用二氧化碳气腹的腹腔镜检查会对心血管和呼吸功能产生不良影响。已证明使用低压力气腹可减少不良血流动力学影响。然而，其对组织创伤、术后疼痛和恢复的影响仍存在争议。本研究的目的是比较两组接受腹腔镜胆囊切除术患者的组织创伤、术后疼痛和恢复情况，一组气腹压力为8mmHg（LC8组），另一组为15mmHg（LC15组）。40例患者被随机分组，每组20例。两组患者的特征相似。LC15组的所有患者均完成了手术，但LC8组有2例患者的压力增加到15mmHg以完成手术。两组之间在术后疼痛评分、镇痛药用量以及恶心、呕吐和肩部疼痛的发生率方面无显著差异。术后C反应蛋白浓度和白细胞计数显著升高，但两组升高情况相似。手术中位持续时间相似，LC8组为23分钟（范围15 - 65分钟），LC15组为25分钟（范围15 - 80分钟）。采用我们的腹腔镜胆囊切除术技术，使用低压力气腹在组织损伤、术后疼痛和恢复方面并无优势。
