Karayiannakis A J, Makri G G, Mantzioka A, Karousos D, Karatzas G
Second Department of Propaedeutic Surgery, University of Athens, Medical School, Greece.
Br J Anaesth. 1996 Oct;77(4):448-52. doi: 10.1093/bja/77.4.448.
In this prospective, randomized study, we compared 42 patients undergoing laparoscopic cholecystectomy and 40 undergoing open cholecystectomy to determine if laparoscopic cholecystectomy results in less respiratory impairment and fewer respiratory complications. Pulmonary function tests, arterial blood-gas analysis and chest radiographs were obtained in both groups before operation and on the second day after operation. Postoperative pain scores and analgesic requirements were also recorded. After operation, a significant reduction in total lung capacity, functional residual capacity (FRC), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and mid-expiratory flow (FEF25-75%) occurred after both laparoscopic and open cholecystectomy. The reductions in FRC, FEV1, FVC and FEF25-75% were smaller after laparoscopic (7%, 22%, 19% and 23%, respectively) than after open (21%, 38%, 32% and 34%, respectively) cholecystectomy. Laparoscopic cholecystectomy was also associated with a significantly lower incidence (28.6% vs 62.5%) and less severe atelectasis, better oxygenation and reduced postoperative pain and analgesia use compared with open cholecystectomy. We conclude that postoperative pulmonary function was impaired less after laparoscopic than after open cholecystectomy.
在这项前瞻性随机研究中，我们比较了42例行腹腔镜胆囊切除术的患者和40例行开腹胆囊切除术的患者，以确定腹腔镜胆囊切除术是否会导致更少的呼吸功能损害和更少的呼吸系统并发症。两组患者在手术前和术后第二天均进行了肺功能测试、动脉血气分析和胸部X光检查。还记录了术后疼痛评分和镇痛需求。手术后，腹腔镜胆囊切除术和开腹胆囊切除术后，总肺容量、功能残气量（FRC）、第1秒用力呼气量（FEV1）、用力肺活量（FVC）和呼气中期流速（FEF25-75%）均显著降低。腹腔镜胆囊切除术后FRC、FEV1、FVC和FEF25-75%的降低幅度（分别为7%、22%、19%和23%）小于开腹胆囊切除术（分别为21%、38%、32%和34%）。与开腹胆囊切除术相比，腹腔镜胆囊切除术还具有显著更低的发病率（28.6%对62.5%）和更轻的肺不张、更好的氧合以及减少的术后疼痛和镇痛药物使用。我们得出结论，腹腔镜胆囊切除术后的肺功能损害比开腹胆囊切除术少。
