Takagi S
Second Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143, Japan.
Surg Endosc. 1998 May;12(5):427-31. doi: 10.1007/s004649900696.
Laparoscopy under carbon dioxide (CO2) pneumoperitoneum has many advantages. However, the risks of CO2 pneumoperitoneum during laparoscopic hepatectomy (LH) have not been defined.
The hemodynamics of the hepatic vein were examined during CO2 pneumoperitoneum both pre- and posthepatectomy in eight pigs. Portal blood flow was measured with Doppler ultrasound during laparoscopic cholecystectomy in 10 human patients.
Experimentally, elevated intraabdominal pressure (IAP) with CO2 insufflation produced significant increases in CO2 partial pressure and echogenicity of the hepatic vein in the posthepatectomy group. Clinically, elevated IAP caused significant narrowing of the portal vein and significant decreases in portal blood velocity. The mean portal flow was significantly decreased with elevation of IAP >10 mmHg.
LH with CO2 pneumoperitoneum may lead to embolism caused by CO2 bubbling through the hepatic vein. Elevated IAP may cause a decrease in hepatic blood flow and induce severe liver damage, especially in patients with poor liver function. Gasless laparoscopy using abdominal wall lifting should be employed in LH to avoid the risks of CO2 embolism and liver damage.
二氧化碳（CO₂）气腹腹腔镜检查有诸多优点。然而，腹腔镜肝切除术（LH）期间CO₂气腹的风险尚未明确。
对8头猪在肝切除术前和术后CO₂气腹期间检查肝静脉的血流动力学。用多普勒超声测量10例人类患者在腹腔镜胆囊切除术期间的门静脉血流。
实验中，在肝切除术后组，随着CO₂充气腹内压（IAP）升高，肝静脉CO₂分压和回声显著增加。临床上，IAP升高导致门静脉显著狭窄，门静脉血流速度显著降低。IAP>10 mmHg升高时平均门静脉血流显著减少。
CO₂气腹的LH可能导致CO₂经肝静脉鼓泡引起栓塞。IAP升高可能导致肝血流减少并诱发严重肝损伤，尤其是肝功能差的患者。LH应采用腹壁提升的无气腹腔镜检查以避免CO₂栓塞和肝损伤风险。
