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目的 探讨二氧化碳气腹对心功能异常的老年人血流动力学和血气的影响。方法 将６０岁以上患胆囊疾病的老年人,合并心血管疾病和部分肺部疾病,心脏功能２级,随机分为腹腔镜胆囊切险术组（１４例）与剖腹组（１０例）。用监测仪观察诱导前、术前及术后５、１０、１５分钟和拔管后５、１０分钟的血流动力学和血气变化。结果 气腹后血压明显升高。８例病人心率减慢,２例心失常,均治愈。气腹后中心静脉压上升至拔管后,明显高于相     

肝肺撞击伤伴失血后CO2气腹对兔心肌酶及标志物影响的实验研究

目的 探讨肝肺撞击伤伴失血后CO2气腹对兔心肌酶及标志物的影响及其机制.方法 制作创伤性失血兔模型,按不同失血量(6、12、22ml/kg)及CO2腹压(5、10、15mm Hg)将新西兰大白兔按随机数字表分为9组(Ⅰ～Ⅸ,n＝6).观察气腹前、气腹后30min时心肌酶(AST、LDH、CK-MB)、心肌标志物(cTnT、Mb)变化.结果 气腹前,各观测指标在22ml/kg失血量组递增显著(P＜0.05).CO2气腹30min后:(1)15mm Hg压力组内各指标均升高显著(P＜0.05);10mm Hg压力组在12、22ml/kg失血量下各指标增加显著(P＜0.05).(2)相同失血量组间:LDH、CK-MB在22ml/kg失血量、15mm Hg腹压较其他腹压组升高明显(P＜0.05).cTnT在6ml/kg失血量、15mm Hg腹压较其他腹压组升高显著(P＜0.05);在12ml/kg失血量,随腹压上升而增高.(3)相同压力组间:AST、LDH、CK-MB、Mb在22ml/kg失血量与其他失血量组差异有统计学意义(P＜0.05);cTnT在5、10mm Hg气腹压力组随失血量增多而增高.结论 cTnT与失血量的变化存在相关关系;创伤伴中度以上失血状态下,CO2气腹可引起并加重兔的心肌损害,其机制与腹内压增加、CO2吸收有关.     

不同腹腔镜腹股沟疝修补术中二氧化碳气腹对酸碱平衡影响随机对照研究

目的 对比CO2气腹在腹腔镜经腹腹膜前修补手术(TAPP)和腹腔镜完全腹膜外修补手术(TEP)中对酸碱平衡代谢的影响结果.方法 收集2019-06-01至2019-11-30首都医科大学附属北京朝阳医院疝和腹壁外科日间病房收治的共100例原发性腹股沟疝病人的临床资料.将全部病人按随机数字表分为TAPP组和TEP组,各5...     

气腹对肿瘤侵袭转移相关分子的影响

肿瘤的侵袭转移和众多分子密切相关,而腹腔镜技术中气腹对其影响已多有报道。现就气腹对肿瘤侵袭转移相关分子的影响、其中可能的机制及相关预防措施进行综述。     

Gasless laparoscopy versus conventional laparoscopy and laparotomy: A systematic review on the safety and efficiency

Background

Gasless laparoscopy (GL) emerged to overcome the clinical and financial challenges of pneumoperitoneum and is often seen as a viable option for use in resource-limited settings as a means of saving costs and resources. This study aims to systematically review the evidence available on the safety and efficiency of GL compared with conventional laparoscopy (CL) and laparotomy.

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Medline, Embase, Web of Science and Cochrane databases were searched. Variables of interest were determined a priori and Covidence software was used to screen studies for inclusion without demographic preference. The quality of studies was assessed using the Cochrane Risk Assessment tool.

Results

Of the 1080 studies screened, a total of 43 studies were included. Laparoscopic cholecystectomy was by far the most studied intervention in randomised studies. In these, the mean setup time for gasless and CL was 13.14 (95% CI −0.16 to 26.44) and 12.8 (95% CI −10.86 to 36.47) minutes, respectively. The mean duration of surgery for gasless and CL was 89.39 (95% CI 77.44 to 101.34) and 72.59 (95% CI 63.44 to 81.74) minutes, respectively, and the mean length of stay was 4.25 (95% CI 2.02 to 6.48) and 4.04 (95% CI 1.72 to 6.36) days, respectively. Most reported complications were haemorrhage and infection with no assessable statistical difference.

Conclusions

Although GL seems to be a feasible approach for many general surgery interventions, the observed outcomes based on safety and efficiency are not sufficient to recommend GL as an alternative to CL or laparotomy. Larger randomised trials with a low risk of bias are warranted.     

二氧化碳气腹对不同年龄组小儿脑氧饱和度和术后躁动的影响

目的 通过观察二氧化碳气腹对不同年龄组小儿脑氧饱和度和术后躁动的影响，探讨小儿脑氧饱和度监测的临床意义。方法 择期行腹腔镜下疝囊高位结扎术患儿90例，ASAⅠ级，按年龄分为3组：1～3岁 为S组（30例）；>3～6岁为M组（30例）；>6～14岁为L组（30例）。采用全凭静脉麻醉，机械通气维持呼 气末二氧化碳分压（PETCO2）在35～45?mmHg。分别于麻醉诱导后（T0）、气腹即刻（T1）、气腹后5?min（T2）、 10?min（T3）、气腹结束（T4）、术后5?min（T5）记录患儿心率（HR）、收缩压（SBP）、血氧饱和度（SpO2）、PETCO2、左脑氧饱和度和右脑氧饱和度；计算脑氧饱和度下降最大幅度%ΔrSO2MAX；记录手术时间、麻醉时间、苏醒时间及苏醒即刻的躁动评分。结果 不同时间点脑氧饱和度比较有差异（P?<0.05），与T0、T1、T4、T5比较，S组患者在T2、T3时间点左脑氧饱和度和右脑氧饱和度下降（P?<0.05）；M、L组各时间点脑氧饱和度比较无差异（P?>0.05）。3组左脑氧饱和度和右脑氧饱和度比较无差异（P?>0.05）。与M、L组比较，S组 的躁动评分升高（P?<0.05）；%ΔrSO2MAX、躁动评分与年龄有相关性（P?<0.05），且S组中%ΔrSO2MAX与年龄呈负相关（P?<0.05），躁动评分与%ΔrSO2MAX无相关性（P?>0.05）。结论 二氧化碳气腹对1～3岁患儿具有潜在脑氧饱和度下降风险，且年龄越小影响越大；苏醒期躁动与脑氧饱和度的下降无相关性。     

Low- versus standard- pneumoperitoneum in patients undergoing robot-assisted radical prostatectomy: a randomised,triple-blinded study

Objective

To investigate the effectiveness and impact of low-pressure pneumoperitoneum (Pnp) on postoperative quality of recovery (QoR) and surgical workspace (SWS) in patients with prostate cancer undergoing robot-assisted radical prostatectomy (RARP).

Patients and Methods

A randomised, triple-blinded trial was conducted in a single centre in Denmark from March 2021 to January 2022. A total of 98 patients with prostate cancer undergoing RARP were randomly assigned to either low-pressure Pnp (7 mmHg) or standard-pressure Pnp (12 mmHg). Co-primary outcomes were postoperative QoR measured via the QoR-15 questionnaire on postoperative Day 1 (POD1), POD3, POD14, and POD30, and SWS assessed intraoperatively by a blinded assessor (surgeon) via a validated SWS scale. Data analysis was performed according to the intention-to-treat principle.

Results

Patients who underwent RARP at low Pnp pressure demonstrated better postoperative QoR on POD1 (mean difference = 10, 95% confidence interval [CI] 4.4–15.5), but no significant differences were observed in the SWS (mean difference = 0.25, 95% CI −0.02 to 0.54). Patients allocated to low-pressure Pnp experienced statistically higher blood loss than those in the standard-pressure Pnp group (mean difference = 67 mL, P = 0.01). Domain analysis revealed significant improvements in pain (P = 0.001), physical comfort (P = 0.007), and emotional state (P = 0.006) for patients with low-pressure Pnp. This trial was registered at ClinicalTrials.gov , NCT04755452, on 16/02/2021.

Conclusion

Performing RARP at low Pnp pressure is feasible without compromising the SWS and improves postoperative QoR, including pain, physical comfort, and emotional state, compared to the standard pressure.     

Ruptured Pyogenic Liver Abscess as an Uncommon Cause of Pneumoperitoneum

Teaching Point: Spontaneous ruptured gas-forming pyogenic liver abscess (GFPLA) is a life-threatening infection that mimics perforation of hollow viscous and need to be accurately diagnosed by computed tomography, which in turn helps to decrease the operative time and improve patient’s prognosis.