腹腔镜或机器人腹部手术后皮下气肿：一项回顾性单中心研究。

Subcutaneous emphysema associated with laparoscopic or robotic abdominal surgery: a retrospective single-center study.

机构信息

Division of Lower GI, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan.

Nursing Department, Hyogo Medical University, Nishinomiya, Japan.

出版信息

Surg Endosc. 2024 Apr;38(4):1969-1975. doi: 10.1007/s00464-024-10701-5. Epub 2024 Feb 20.

DOI:10.1007/s00464-024-10701-5

PMID:38379005

Abstract

BACKGROUND

Subcutaneous emphysema (SCE) is a common complication in laparoscopic surgery. However, its precise incidence and impact on the clinical course are partially known. In this study, the incidence and risk factors of SCE were retrospectively analyzed.

METHODS

Patients who underwent laparoscopic/robotic abdominal surgery (e.g., gastrointestinal, hepatobiliary, gynecologic, and urologic surgery) between October 2019 and September 2022 were retrospectively analyzed. The presence of SCE was confirmed by either conclusive findings obtained through chest/abdominal X-ray examination immediately after operation, or intraoperative palpation conducted by nurses. X-ray examination was performed in the operation room before extubation.

RESULTS

A total of 2503 patients treated with laparoscopic/robotic abdominal surgery between October 2019 and September 2022 were identified and all of them were included in the analysis. SCE was confirmed in 23.1% of the patients (i.e., 577/2503). SCE was identified by X-ray examination in 97.6% of the patients. Extubation failure was observed in 10 patients; however, pneumothorax was not observed. Female sex (odds ratio [OR]: 2.09; 95% confidence interval [95%CI]: 1.69-2.57), age ≥ 80 years (OR 1.63; 95%CI 1.19-2.22), body mass index < 20 (OR 1.32; 95%CI 1.06-1.65), operation time > 360 min (OR 1.97; 95%CI 1.53-2.54), robotic surgery (OR 2.54; 95%CI 1.91-3.38), maximum intraabdominal pressure with CO > 15 mmHg (OR 1.79; 95%CI 1.02-3.16), and endo-tidal CO > 50 mmHg (OR 1.32; 95%CI 1.08-1.62)were identified as independent factors of SCE. Regarding the extubation failure due to SCE, age (OR 5.84; 95%CI 1.27-26.8) and maximum intraabdominal pressure with CO (OR 21.7; 95%CI 4.76-99.3) were identified as risk factors.

CONCLUSION

Although the presence of SCE is associated with a low risk of severe complications, monitoring of the perioperative intraabdominal pressure is essential for performing safe laparoscopic/robotic surgery, particularly in elderly patients.

摘要

背景

皮下气肿（SCE）是腹腔镜手术中的常见并发症。然而，其确切的发生率和对临床病程的影响尚不完全清楚。本研究回顾性分析了 SCE 的发生率和危险因素。

方法

回顾性分析了 2019 年 10 月至 2022 年 9 月期间接受腹腔镜/机器人腹部手术（如胃肠道、肝胆、妇科和泌尿科手术）的患者。通过术后立即进行的胸部/腹部 X 射线检查或护士进行的术中触诊确认 SCE 的存在。在拔管前在手术室进行 X 射线检查。

结果

共确定了 2019 年 10 月至 2022 年 9 月期间接受腹腔镜/机器人腹部手术的 2503 例患者，所有患者均纳入分析。23.1%的患者（即 577/2503）确认存在 SCE。97.6%的患者通过 X 射线检查发现 SCE。有 10 例患者发生拔管失败，但未发生气胸。女性（比值比 [OR]：2.09；95%置信区间 [95%CI]：1.69-2.57）、年龄≥80 岁（OR 1.63；95%CI 1.19-2.22）、BMI<20（OR 1.32；95%CI 1.06-1.65）、手术时间>360 分钟（OR 1.97；95%CI 1.53-2.54）、机器人手术（OR 2.54；95%CI 1.91-3.38）、最大腹腔内压力伴 CO>15mmHg（OR 1.79；95%CI 1.02-3.16）和呼气末 CO>50mmHg（OR 1.32；95%CI 1.08-1.62）是 SCE 的独立危险因素。关于因 SCE 导致的拔管失败，年龄（OR 5.84；95%CI 1.27-26.8）和最大腹腔内压力伴 CO（OR 21.7；95%CI 4.76-99.3）是危险因素。