Vijayaraghavan Nandhagopal, Sistla Sarath Chandra, Kundra Pankaj, Ananthanarayan Palghat Hariharan, Karthikeyan Vilvapathy Senguttuvan, Ali Sheik Manwar, Sasi Sajith P, Vikram Krishnamurthy
Departments of *Plastic Surgery †Surgery ‡Anesthesiology and Critical Care §Biochemistry ∥Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry ¶Department of Community Medicine, University College of Medical Sciences (UCMS), New Delhi, India.
Surg Laparosc Endosc Percutan Tech. 2014 Apr;24(2):127-33. doi: 10.1097/SLE.0b013e3182937980.
With the safety of laparoscopic cholecystectomy (LC) having been established, the current stress is on reducing the postoperative morbidity associated with this procedure. Hence, this study was undertaken to compare the effect of low-pressure (8 mm Hg) (LPLC) versus standard-pressure (12 mm Hg) (SPLC) pneumoperitoneum on postoperative pain, respiratory and liver functions, the stress response, and the intraoperative surgeon comfort in patients undergoing LC.
Patients undergoing LC (n=43) were randomized into the LPLC (8 mm Hg) group (n=22) and the SPLC (12 mm Hg) group (n=21). Postoperative pain, changes in liver function, peak expiration flow rate, C-reactive protein level, and intraoperative surgeon comfort were assessed.
The postoperative pain scores (P=0.003, 0.000, 0.001, and 0.002 at 0, 4, 8, and 24 h), total analgesic requirement (P=0.001), and the number (total and good) of demands for analgesic in the first 24 hours (P=0.002 and 0.001) were lower in the LPLC group. The surgeon comfort in the LPLC group was significantly lesser (P=0.000). The liver function and peak expiration flow rate did not show any significant changes. C-reactive protein levels varied significantly only at 24 hours postoperatively (P=0.001).
The use of low-pressure pneumoperitoneum (8 mm Hg) for LC is associated with a significantly lower postoperative pain. However, the use of this low-pressure pneumoperitoneum can jeopardize the surgeon's comfort.
随着腹腔镜胆囊切除术（LC）安全性的确立，当前的重点是降低该手术相关的术后发病率。因此，本研究旨在比较低压（8毫米汞柱）气腹（LPLC）与标准压力（12毫米汞柱）气腹（SPLC）对接受LC患者术后疼痛、呼吸和肝功能、应激反应以及术中外科医生舒适度的影响。
接受LC的患者（n = 43）被随机分为LPLC（8毫米汞柱）组（n = 22）和SPLC（12毫米汞柱）组（n = 21）。评估术后疼痛、肝功能变化、呼气峰值流速、C反应蛋白水平和术中外科医生舒适度。
LPLC组术后疼痛评分（0、4、8和24小时时P分别为0.003、0.000、0.001和0.002）、总镇痛需求量（P = 0.001）以及前24小时内镇痛需求的次数（总数和好次数）（P分别为0.002和0.001）均较低。LPLC组外科医生的舒适度明显较低（P = 0.000）。肝功能和呼气峰值流速未显示任何显著变化。C反应蛋白水平仅在术后24小时有显著差异（P = 0.001）。
LC使用低压气腹（8毫米汞柱）与术后疼痛显著降低相关。然而，使用这种低压气腹会影响外科医生的舒适度。
