The effects of isothermic and hypothermic carbon dioxide pneumoperitoneum on respiratory function test results

Background/Purpose

This study investigated the effects of isothermic and hypothermic carbon dioxide, used for pneumoperitoneum during laparoscopic cholecystectomy, on respiratory function test results.

Methods

Thirty patients who underwent elective laparoscopic cholecystectomy were enrolled in this prospective randomized study. The patients were divided into two groups. Carbon dioxide at 37?°C (isothermic) was used in the isothermic group, and carbon dioxide at 21?°C (hypothermic) was used in the hypothermic group. Respiratory function tests were performed in the preoperative period and at 12?h after the operation.

Results

Mean forced vital capacity (FVC), forced expiratory volume (FEV1), maximum peak expiratory flow (PEF), and the FEV1/FVC ratio were significantly higher in the isothermic group than in the hypothermic group (P < 0.05).

Conclusions

Using isothermic carbon dioxide for pneumoperitoneum has fewer negative effects than hypothermic carbon dioxide on respiratory function tests results. Isothermic carbon dioxide may be preferable for patients with respiratory problems.     

CO2气腹对裸鼠腹腔种植肿瘤MMP-2和TIMP-1蛋白表达的影响

目的评价CO2气腹及不同气腹压力对裸鼠腹腔种植肿瘤基质金属蛋白酶-2（MMP-2）和基质金属蛋白酶抑制剂-1（TIMP-1）蛋白表达的影响。方法 30只裸鼠建立腹腔种植肿瘤模型,造模成功后随机分组：对照组、5mmHg和10mmHgCO2气腹组,气腹作用时间1h。气腹干预后1周检测肿瘤组织MMP2、TIMP-1蛋白表达情况。结果与对照组比较,气腹干预后1周5mmHg和10mmHgCO2气腹组肿瘤组织MMP-2蛋白表达均显著升高（P〈0.01）,且10mmHg组高于5mmHg组（P〈0.01）。两组TIMP-1表达降低,且10mmHg组低于5mmHg组（P〈0.01）。MMP-2/TIMP-1比例下降,10mmHg组下降更为显著（P〈0.01）。结论 ：CO2气腹作用后早期可使肿瘤组织MMP-2升高,TIMP-1下降,气腹压力高作用更为明显。     

二氧化碳气腹对腹腔镜手术患者肾功能的影响

目的 研究不同的二氧化碳(CO2)气腹持续时间对患者肾功能的影响.方法 2009年10月至2011年12月行腹腔镜手术患者89例,根据手术时间不同分成3组,即T1组(＜1 h)、T2组(1～2h)和T3组(＞2 h);所有患者分别于术前、术后10 min、1h、24h检测血肌酐、尿肌酐和尿微量白蛋白.结果 T1组和T2组中患者术后内生肌酐清除率(Cer)较术前差异均无统计学意义(P均＞0.05),T3组中患者术后10 min Ccr较术前显著降低,差异有统计学意义(P＜0.05),术后1h和24h逐渐升高;尿微量白蛋白/尿肌酐比值(A/C)3组患者在术后均较术前显著升高,差异均有统计学意义(P均＜0.05),但术后3组之间差异无统计学意义(P ＞0.05);T1组中≥60岁和＜60岁患者术后的肾功能比较差异均无统计学意义(P均＞0.05),T2、T3组中≥60岁患者在术后24h中Ccr均低于＜60岁患者,差异有统计学意义(P均＜0.05).结论 长时间的CO2气腹可对肾功能产生显著的急性影响,在≥60岁的患者中更加明显,但在较短的时间内肾功能可逐渐恢复.     

Recurrent Non-surgical Pneumoperitoneum Due to Jejunal Diverticulosis

Background: The presence of free intraperitoneal gas usually warrants emergent surgery. In rare instances, however, non-surgical conditions such as jejunal diverticulosis can cause pneumoperitoneum and do not require intervention. Objectives: The objective of this article is to provide the computed tomography (CT) scan findings of jejunal diverticulosis causing pneumoperitoneum. The article will also discuss other non-surgical causes of spontaneous pneumoperitoneum to increase awareness and avoid unnecessary surgery. Case Report: We describe a case of recurrent pneumoperitoneum due to jejunal diverticulosis in which the patient remained asymptomatic and free of complications with repeated evaluations in the emergency department over the course of 18 months. Conclusion: Although spontaneous pneumoperitoneum due to jejunal diverticulosis is a rare finding, when it does occur, this condition must be distinguished from other forms of pneumoperitoneum to avoid unnecessary surgery. CT scan findings of multiple rounded, variably sized jejunal outpouchings filled with oral contrast are helpful in diagnosing jejunal diverticulosis and confirming the decision for conservative management of the patient.     

Carbon dioxide embolism during laparoscopic surgery

Clinically significant carbon dioxide embolism is a rare but potentially fatal complication of anesthesia administered during laparoscopic surgery. Its most common cause is inadvertent injection of carbon dioxide into a large vein, artery or solid organ. This error usually occurs during or shortly after insufflation of carbon dioxide into the body cavity, but may result from direct intravascular insufflation of carbon dioxide during surgery. Clinical presentation of carbon dioxide embolism ranges from asymptomatic to neurologic injury, cardiovascular collapse or even death, which is dependent on the rate and volume of carbon dioxide entrapment and the patient's condition. We reviewed extensive literature regarding carbon dioxide embolism in detail and set out to describe the complication from background to treatment. We hope that the present work will improve our understanding of carbon dioxide embolism during laparoscopic surgery.     

后腹腔镜气腹对老年患者PaCO_2与PetCO_2相关性及循环的影响

目的探讨后腹腔镜手术期间呼气末二氧化碳分压（PetCO2）与动脉血二氧化碳分压（PaCO2）的相关关系以及后腹腔镜气腹对老年患者术中循环的影响。方法选择60岁以上择期行腹膜后腹腔镜手术患者70例,ASAⅠ～Ⅱ级。于诱导后10 min、气腹后15、30 min,停气腹后15、30 min行动脉血气分析,并记录相应时间的Pet-CO2、PaCO2,求出PaCO2与PetCO2差值（Pa-etCO2）。同时记录相应时间点收缩压（SBP）、舒张压（DBP）、心率（HR）的变化。结果气腹后15、30 min,停气腹后15、30 min PaCO2、PetCO2、SBP与气腹前比较均升高（P〈0.05,〈0.01）。不同时间点PaCO2与PetCO2之间存在显著性相关。结论老年患者腹膜后腹腔镜手术PaCO2与Pet-CO2相关性良好,PetCO2能较好地反映PaCO2变化。气腹对老年患者SBP的影响明显。     

高龄患者行腹腔镜直肠癌根治术CO2气腹对循环及呼吸功能的影响

目的探讨高龄患者行腹腔镜直肠癌根治术中CO2气腹对循环及呼吸功能的影响。方法 60例腹腔镜直肠癌根治术病人均采用气管内插管全麻,分别于气腹前、腹后15、30 min、放气腹后15、30 min,记录心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、中心静脉压（CVP）、呼气末CO2分压（PETCO2）、气道峰压（Ppeak）及血气值。结果气腹后15 min与气腹前比,HR、SBP、DBP、MAP、CVP、PETCO2、PaCO2、Ppeak均明显升高（P〈0.05）,pH值明显降低（P〈0.05）。结论高龄患者行腹腔镜直肠癌根治术对患者血流动力学会产生一定的影响,通过加强术中循环功能的监测和管理,可在短时间内恢复接近于正常水平;CO2气腹导致的高碳酸血症及酸中毒,通过调整分钟通气量可得到纠正。     

不同压力CO2气腹对腹腔内感染炎症反应的影响

目的：研究不同气压CO2气腹对腹腔感染炎症反应的影响。方法：将60例急性胆囊炎病例随机分为低气压气腹组（8—10mmHg）和高气压气腹组（12～14mmHg）,分别于术前、术后3h、24h、3d采血化验白细胞数,检测其血清CRP、IL-6、TNF—α水平,评价不同气压CO2气腹对腹腔感染炎症反应的影响。结果：高气压气腹组在多个时间段CRP、IL-6、TNF-α水平显著高于低气压气腹组。结论：低气压气腹较高气压气腹对腹腔内感染影响较轻。     

Abdominal access techniques

This article discusses the variety of techniques available to gain safe exposure to intra-abdominal organs. In recent years there have been significant advances in these techniques with a move towards minimally invasive strategies as the gold standard of care. This article will discuss the various options available, including laparoscopy and traditional open access, as well as the use of robotics within abdominal surgery.