Johnson D, Litwin D, Osachoff J, McIntosh D, Bersheid B, Church D, Yip R, Gallagher C
Department of Medicine, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
Surg Laparosc Endosc. 1992 Sep;2(3):221-6.
Open cholecystectomy causes changes in pulmonary function test volumes; such changes can be related to respiratory complications of hypoxemia and atelectasis. Little data is available on lung volume changes after laparoscopic cholecystectomy. We measured preoperative and postoperative vital capacity (VC), functional residual capacity (FRC), arterial PO2, and chest X-ray atelectasis in 31 patients undergoing laparoscopic cholecystectomy and found small but significant decreases (p < 0.01) in VC (13 +/- 19%) and FRC (7 +/- 17%). The PO2 decreased from 89 +/- 11 mm Hg to 82 +/- 14 mm Hg, with only one patient's PO2 less than 60 mm Hg. Three patients demonstrated new segmental lobar collapse on postoperative chest X-ray. The postoperative changes in FRC (R2 = 0.40, p < 0.04) and atelectasis (R2 = 0.46, p < 0.03) could be predicted by multiple regression of risk factors, including obesity, smoking, use of narcotics, age, and symptoms of prior respiratory disease. We conclude that the respiratory changes after laparoscopic surgery are small in comparison to those expected after open cholecystectomy.
开腹胆囊切除术会导致肺功能测试容积发生变化；此类变化可能与低氧血症和肺不张等呼吸并发症有关。关于腹腔镜胆囊切除术后肺容积变化的数据很少。我们对31例行腹腔镜胆囊切除术的患者术前和术后的肺活量（VC）、功能残气量（FRC）、动脉血氧分压（PO2）以及胸部X线肺不张情况进行了测量，发现VC（13±19%）和FRC（7±17%）有小幅但显著的下降（p<0.01）。PO2从89±11mmHg降至82±14mmHg，只有1例患者的PO2低于60mmHg。3例患者术后胸部X线显示有新的节段性肺叶萎陷。通过对包括肥胖、吸烟、使用麻醉剂、年龄及既往呼吸系统疾病症状等危险因素进行多元回归分析，可预测术后FRC的变化（R2=0.40，p<0.04）以及肺不张情况（R2=0.46，p<0.03）。我们得出结论，与开腹胆囊切除术后预期的呼吸变化相比，腹腔镜手术后的呼吸变化较小。
