Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Cochrane Database Syst Rev. 2022 Mar 15;3(3):CD009569. doi: 10.1002/14651858.CD009569.pub4.
This is the second update of a Cochrane Review first published in 2013 and last updated in 2017. Laparoscopic surgery is now widely performed to treat various abdominal diseases. Currently, carbon dioxide is the most frequently used gas for insufflation of the abdominal cavity (pneumoperitoneum). Although carbon dioxide meets most of the requirements for pneumoperitoneum, the absorption of carbon dioxide may be associated with adverse events. Therefore, other gases have been introduced as alternatives to carbon dioxide for establishing pneumoperitoneum.
To assess the safety, benefits, and harms of different gases (e.g. carbon dioxide, helium, argon, nitrogen, nitrous oxide, and room air) used for establishing pneumoperitoneum in participants undergoing laparoscopic abdominal or gynaecological pelvic surgery.
We searched CENTRAL, Ovid MEDLINE, Ovid Embase, four other databases, and three trials registers on 15 October 2021 together with reference checking, citation searching, and contact with study authors to identify additional studies.
We included randomised controlled trials (RCTs) comparing different gases for establishing pneumoperitoneum in participants (irrespective of age, sex, or race) undergoing laparoscopic abdominal or gynaecological pelvic surgery under general anaesthesia.
We used standard methodological procedures expected by Cochrane.
We included 10 RCTs, randomising 583 participants, comparing different gases for establishing pneumoperitoneum: nitrous oxide (four trials), helium (five trials), or room air (one trial) was compared to carbon dioxide. All the RCTs were single-centre studies. Four RCTs were conducted in the USA; two in Australia; one in China; one in Finland; one in Iran; and one in the Netherlands. The mean age of the participants ranged from 27.6 years to 49.0 years. Four trials randomised participants to nitrous oxide pneumoperitoneum (132 participants) or carbon dioxide pneumoperitoneum (128 participants). None of the trials was at low risk of bias. The evidence is very uncertain about the effects of nitrous oxide pneumoperitoneum compared to carbon dioxide pneumoperitoneum on cardiopulmonary complications (Peto odds ratio (OR) 2.62, 95% CI 0.78 to 8.85; 3 studies, 204 participants; very low-certainty evidence), or surgical morbidity (Peto OR 1.01, 95% CI 0.14 to 7.31; 3 studies, 207 participants; very low-certainty evidence). There were no serious adverse events related to either nitrous oxide or carbon dioxide pneumoperitoneum (4 studies, 260 participants; very low-certainty evidence). Four trials randomised participants to helium pneumoperitoneum (69 participants) or carbon dioxide pneumoperitoneum (75 participants) and one trial involving 33 participants did not state the number of participants in each group. None of the trials was at low risk of bias. The evidence is very uncertain about the effects of helium pneumoperitoneum compared to carbon dioxide pneumoperitoneum on cardiopulmonary complications (Peto OR 1.66, 95% CI 0.28 to 9.72; 3 studies, 128 participants; very low-certainty evidence), or surgical morbidity (5 studies, 177 participants; very low-certainty evidence). There were three serious adverse events (subcutaneous emphysema) related to helium pneumoperitoneum (3 studies, 128 participants; very low-certainty evidence). One trial randomised participants to room air pneumoperitoneum (70 participants) or carbon dioxide pneumoperitoneum (76 participants). The trial was at high risk of bias. There were no cardiopulmonary complications, serious adverse events, or deaths observed related to either room air or carbon dioxide pneumoperitoneum. AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effects of nitrous oxide, helium, and room air pneumoperitoneum compared to carbon dioxide pneumoperitoneum on any of the primary outcomes, including cardiopulmonary complications, surgical morbidity, and serious adverse events. The safety of nitrous oxide, helium, and room air pneumoperitoneum has yet to be established, especially in people with high anaesthetic risk.
这是 2013 年首次发表并于 2017 年最后更新的 Cochrane 综述的第二次更新。腹腔镜手术现在广泛用于治疗各种腹部疾病。目前，二氧化碳是最常用于腹腔充气（气腹）的气体。尽管二氧化碳满足气腹的大多数要求，但二氧化碳的吸收可能与不良事件有关。因此，已经引入了其他气体作为二氧化碳的替代品来建立气腹。
评估在接受全身麻醉下进行腹腔镜腹部或妇科盆腔手术的参与者中，使用不同气体（如二氧化碳、氦气、氩气、氮气、一氧化二氮和空气）建立气腹的安全性、益处和危害。
我们于 2021 年 10 月 15 日检索了 CENTRAL、Ovid MEDLINE、Ovid Embase、其他四个数据库和三个试验登记处，并通过参考文献检查、引文搜索和与研究作者联系来确定其他研究。
我们纳入了比较不同气体在全身麻醉下接受腹腔镜腹部或妇科盆腔手术的参与者中建立气腹的随机对照试验（RCT）。
我们使用了 Cochrane 预期的标准方法学程序。
我们纳入了 10 项 RCT，共纳入 583 名参与者，比较了不同气体用于建立气腹：比较了一氧化二氮（四项试验）、氦气（五项试验）或空气（一项试验）与二氧化碳。所有 RCT 均为单中心研究。四项 RCT 在美国进行；两项在澳大利亚；一项在中国；一项在芬兰；一项在伊朗；一项在荷兰。参与者的平均年龄范围从 27.6 岁到 49.0 岁。四项试验将参与者随机分配到一氧化二氮气腹（132 名参与者）或二氧化碳气腹（128 名参与者）。没有一项试验的偏倚风险低。与二氧化碳气腹相比，关于一氧化二氮气腹对心肺并发症（Peto 优势比（OR）2.62，95%CI 0.78 至 8.85；3 项研究，204 名参与者；极低确定性证据）或手术发病率（Peto OR 1.01，95%CI 0.14 至 7.31；3 项研究，207 名参与者；极低确定性证据）的影响，证据非常不确定。没有与一氧化二氮或二氧化碳气腹相关的严重不良事件（4 项研究，260 名参与者；极低确定性证据）。四项试验将参与者随机分配到氦气气腹（69 名参与者）或二氧化碳气腹（75 名参与者），一项涉及 33 名参与者的试验未报告每组的参与者人数。没有一项试验的偏倚风险低。与二氧化碳气腹相比，关于氦气气腹对心肺并发症（Peto OR 1.66，95%CI 0.28 至 9.72；3 项研究，128 名参与者；极低确定性证据）或手术发病率（5 项研究，177 名参与者；极低确定性证据）的影响，证据非常不确定。有 3 例与氦气气腹相关的严重不良事件（皮下气肿）（3 项研究，128 名参与者；极低确定性证据）。一项试验将参与者随机分配到空气气腹（70 名参与者）或二氧化碳气腹（76 名参与者）。该试验存在高偏倚风险。未观察到与空气或二氧化碳气腹相关的心肺并发症、严重不良事件或死亡。
与二氧化碳气腹相比，关于氮氧化物、氦气和气腹对任何主要结局的影响，包括心肺并发症、手术发病率和严重不良事件，证据非常不确定。氮氧化物、氦气和气腹的安全性尚未确定，尤其是在具有高麻醉风险的人群中。
