Keus F, Ahmed Ali U, Noordergraaf G J, Roukema J A, Gooszen H G, van Laarhoven C J H M
Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
Acta Anaesthesiol Scand. 2007 Sep;51(8):1068-78. doi: 10.1111/j.1399-6576.2007.01386.x.
Upper abdominal surgery, including laparoscopic cholecystectomy (LC), is associated with post-operative pulmonary dysfunction. LC has, by consensus, become the treatment of choice for symptomatic cholecystolithiasis. Small-incision cholecystectomy (SIC), a procedure that does not require a pneumoperitoneum, threatens to be lost to clinical practice, even though there is evidence of equality. We hypothesized that the SIC technique should be equal, and might even be superior, to LC when considering post-operative pulmonary function because of the short incision length.
A single-centre randomized clinical trial was performed including patients scheduled for elective cholecystectomy. Pulmonary flow-volume curves were measured pre-operatively, post-operatively and at follow-up. Blood gas analyses were measured pre-operatively, in the recovery phase and on post-operative day 1. Anaesthesia, analgesics and peri-operative care were standardized by protocol. Post-operatively, patients and caregivers were blind to the procedure.
Two hundred and fifty-seven patients were analysed. There was one pulmonary complication (pneumonia) in the LC group. In both groups, similar reductions of approximately 20% in pulmonary function parameters occurred, with complete recovery to pre-operative values. Patients in the SIC group consumed more analgesia when compared with the LC group, without any impact on blood gas analysis. Patients converted to a conventional open technique showed significant differences in six of the eight parameters in pulmonary function tests.
When evaluated with strict methodology and standardization of care, no clinically relevant differences were found between SIC and LC with regard to pulmonary function. Our results suggest that the popularity of the laparoscopic technique cannot be attributed to pulmonary preservation.
上腹部手术，包括腹腔镜胆囊切除术（LC），与术后肺功能障碍相关。目前，LC已成为有症状胆囊结石的首选治疗方法。小切口胆囊切除术（SIC）是一种无需气腹的手术，尽管有证据表明其疗效相当，但该手术在临床实践中可能会被淘汰。我们推测，由于切口长度较短，在考虑术后肺功能时，SIC技术应与LC相当，甚至可能更优。
进行了一项单中心随机临床试验，纳入计划进行择期胆囊切除术的患者。术前、术后及随访时测量肺流量-容积曲线。术前、恢复阶段及术后第1天进行血气分析。麻醉、镇痛及围手术期护理均按照方案标准化。术后，患者及护理人员对手术方式不知情。
共分析了257例患者。LC组有1例肺部并发症（肺炎）。两组肺功能参数均出现类似的约20%的下降，并完全恢复至术前值。与LC组相比，SIC组患者使用的镇痛药物更多，但对血气分析无任何影响。转为传统开放手术的患者在肺功能测试的8项参数中有6项存在显著差异。
当采用严格的方法和标准化护理进行评估时，SIC和LC在肺功能方面未发现临床相关差异。我们的结果表明，腹腔镜技术的普及不能归因于对肺功能的保护。
