Chiu A W, Chang L S, Birkett D H, Babayan R K
Department of Surgery, National Yang-Ming University, School of Medicine, Taiwan, Republic of China.
J Am Coll Surg. 1995 Nov;181(5):397-406.
The use of therapeutic laparoscopy has become widespread recently. It is important to assess the effects of gaseous and gasless laparoscopy on systemic and renal hemodynamics.
A prospective controlled animal study was performed on 40 well-hydrated pigs. Systemic and renal hemodynamics were monitored during peritoneal insufflation, retroperitoneal insufflation, and abdominal wall lifting for a period of two hours. A laser Doppler flow meter was applied laparoscopically to measure the renal cortical tissue perfusion.
Peritoneal insufflation of carbon dioxide to a pressure of 15 mm Hg elicited transient elevations of the aortic pressure and carotid arterial blood flow. Unilateral pneumoretroperitoneum caused a smaller change on systemic hemodynamics. Pneumoperitoneum and pneumoretroperitoneum caused oliguria. Superficial renal cortical blood flow reduction decreased by an average of 60 percent in the compressed kidney, and blood flow returned to the pre-insufflation level after the pressure was released. A gradual decrease of tissue perfusion in the contralateral kidney and a concomitant gradual increase of the intra-abdominal pressure were observed when pneumo-retroperitoneum was maintained for two hours. No significant changes in urinary output and in systemic and renal hemodynamics were found when the abdominal wall was lifted up with a force equivalent to 15 mm Hg.
Significant systemic and renal hemodynamic changes were elicited in gaseous but not in gasless laparoscopy, which may explain the decreased urinary output observed during gaseous laparoscopy. Pneumoperitoneum caused greater systemic and renal hemodynamic alterations than pneumoretroperitoneum; however, the effects were transient and reversible after a period of two hours.
近年来，治疗性腹腔镜检查的应用已变得广泛。评估气腹和无气腹腔镜检查对全身和肾脏血流动力学的影响很重要。
对40只水分充足的猪进行了一项前瞻性对照动物研究。在腹膜充气、腹膜后充气和腹壁抬起过程中监测全身和肾脏血流动力学，持续两小时。使用激光多普勒流量计通过腹腔镜测量肾皮质组织灌注。
将二氧化碳充入腹膜至压力为15 mmHg时，引起主动脉压力和颈动脉血流的短暂升高。单侧腹膜后充气对全身血流动力学的影响较小。气腹和腹膜后充气均导致少尿。受压肾脏的浅表肾皮质血流平均减少60%，压力释放后血流恢复到充气前水平。当腹膜后充气维持两小时时，观察到对侧肾脏组织灌注逐渐减少，同时腹腔内压力逐渐升高。当用相当于15 mmHg的力抬起腹壁时，尿量、全身和肾脏血流动力学均未发现明显变化。
气腹腹腔镜检查引起显著的全身和肾脏血流动力学变化，而无气腹腔镜检查则未引起，这可能解释了气腹腹腔镜检查期间观察到的尿量减少。气腹比腹膜后充气引起更大的全身和肾脏血流动力学改变；然而，这些影响是短暂的，两小时后可逆。
