改良腹膜外内镜下腹部间隔综合征部分脏器分离术

Modified extraperitoneal endoscopic separation of parts for abdominal compartment syndrome.

作者信息

Barnes G S, Papasavas P K, O'Mara M S, Urbandt J, Hayetian F D, Gagné D J, Newton E D, Caushaj P F

机构信息

Department of Surgery, The Western Pennsylvania Hospital, Temple University School of Medicine Clinical Campus, Pittsburgh, PA 15224, USA.

出版信息

Surg Endosc. 2004 Nov;18(11):1636-9. doi: 10.1007/s00464-004-8910-1. Epub 2004 Oct 11.

DOI:10.1007/s00464-004-8910-1

PMID:15931474

Abstract

BACKGROUND

Standard therapy for abdominal compartment syndrome (ACS) is laparotomy and temporary abdominal wall closure with significant morbidity. The component separation technique allows for difficult abdominal closure. We studied a modified extraperitoneal endoscopic separation of parts technique on an animal model of ACS.

METHODS

Twelve anesthetized pigs were instrumented for measurement of central venous pressure, arterial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, and intraabdominal pressure (IAP). ACS to 25 mmHg was created by infusing saline into an intraabdominally placed bag. Animals were divided in two equal groups. Pigs in group A underwent minimally invasive resection of the nerves supplying the rectus muscles bilaterally. Pigs in group B underwent minimally invasive modified component separation technique bilaterally. Change in IAP and other physiological parameters were recorded.

RESULTS

(Group A) IAP increased significantly from 7.3 mmHg +/- 3.8 to 25.2 mmHg +/- 1.5 with infusion of saline. Following nerve transection on the right side there was a nonsignificant decrease in IAP from 25.2 mmHg +/- 1.5 to 22.3 mmHg +/- 1.4 and following nerve transection on the left side there was a further decrease in IAP to 20.3 mmHg +/- 1.9. (Group B) IAP increased significantly from 3.8 mmHg +/- 0.4 to 24.7 mmHg +/- 0.5 with infusion of saline. Following separation of parts on the right side there was a significant decrease in IAP from 24.7 mmHg +/- 0.5 to 15.0 mmHg +/- 1.7 and there was a further decrease in IAP to 11.3 mmHg +/- 1.4 following separation of parts on the left side. The only significant change in the physiological parameters measured was observed in CVP in both groups.

CONCLUSION

We present a porcine model of extraperitoneal endoscopic release of abdominal wall components as a treatment option for ACS.

摘要

背景

腹腔间隔室综合征（ACS）的标准治疗方法是剖腹手术和临时腹壁关闭，其发病率较高。成分分离技术有助于困难的腹壁关闭。我们在ACS动物模型上研究了一种改良的腹膜外内镜下部分分离技术。

方法

对12只麻醉猪进行仪器安装，以测量中心静脉压、动脉压、肺动脉压、肺毛细血管楔压、心输出量和腹腔内压（IAP）。通过向腹腔内放置的袋子中注入生理盐水，使IAP达到25 mmHg来建立ACS。动物被分为两组，每组数量相等。A组猪双侧接受微创切除供应腹直肌的神经。B组猪双侧接受微创改良成分分离技术。记录IAP和其他生理参数的变化。

结果

（A组）随着生理盐水的注入，IAP从7.3 mmHg±3.8显著增加至25.2 mmHg±1.5。右侧神经切断后，IAP从25.2 mmHg±1.5略有下降至22.3 mmHg±1.4，左侧神经切断后，IAP进一步下降至20.3 mmHg±1.9。（B组）随着生理盐水的注入，IAP从3.8 mmHg±0.4显著增加至24.7 mmHg±0.5。右侧部分分离后，IAP从24.7 mmHg±0.5显著下降至15.0 mmHg±1.7，左侧部分分离后，IAP进一步下降至11.3 mmHg±1.4。在两组中，所测量的生理参数中唯一显著的变化是在中心静脉压中观察到的。