低气腹压在老年患者腹腔镜完全腹膜外疝修补术中的应用

目的探讨6mmHg（1 mmHg=0.133 kPa）气腹压在腹腔镜完全腹膜外疝修补术（TEP）中的应用。 方法第一阶段将60例心肺功能良好、年龄<75岁的非高龄单侧腹股沟斜疝患者随机分为A、B组,每组30例。A组气腹压力设定为14 mmHg，B组气腹压力设定6 mmHg，比较2组手术医师的手术视野满意度、手术时间、气腹时间、手术麻醉期不同时间点的气道压及呼气末二氧化碳分压（P_ETCO₂）、出院时间、手术并发症发生率。 结果3组患者住院时间差异无统计学意义（P>0.05）。在手术时间和气腹时间方面，与A组相比，B组和C组均略长，差异有统计学意义（P<0.05），B组和C组之间差异无统计学意义（P>0.05）。A组手术视野满意度（4.30±0.65）分优于B组（4.28±0.63）分、C组（4.42±0.64）分，差异均有统计学意义（P<0.05）；B组与C组手术视野满意度差异无统计学意义（P>0.05）。3组患者术后并发症发生率比较，差异均无统计学意义（P>0.05）。3组患者T1、T2及T3的Paw及P_ETCO₂与同组T0比较，差异均有统计学意义（P<0.05）。B组和C组T1、T2及T3的Paw及P_ETCO₂与A组比较，差异均有统计学意义（P<0.05）；其余指标比较，差异均无统计学意义（P>0.05）。 结论6 mmHg低气腹压TEP手术用于部分高龄以及心肺功能较差的患者，可以确切降低术中气道压及P_ETCO₂，增加手术安全性及耐受性，虽轻度影响手术的操作视野及空间，但并不影响手术的顺利完成，术后并发症的发生率及出院时间未受明显影响。

Application of low pneumoperitoneum pressure in TEP for elderly patients

ObjectiveTo investigate the application of 6mmHg (1 mmHg=0.133 kPa) pneumoperitoneum pressure in laparoscopic total extraperitoneal hernia repair (TEP). MethodsIn the first stage, 60 non elderly patients with unilateral indirect inguinal hernia and good cardiopulmonary function and less than 75 years old were randomly divided into group A and B, with 30 patients in each group. The pneumoperitoneum pressure in group A was set at 14mmHg, and that in group B was set at 6mmHg. The satisfaction of the surgical field of surgeons, the operation time, the pneumoperitoneum time, the airway pressure at different time points during the anesthesia period, the end expiratory PaCO₂, the discharge time, and the incidence of surgical complications were compared between the two groups. ResultsThere was no significant difference in hospital stay among the three groups (P>0.05). In terms of the operation time and pneumoperitoneum time, compared with group A, group B and group C were slightly longer, the difference was statistically significant (P<0.05), and there was no significant difference between group B and group C (P>0.05). The satisfaction with surgical field in group A (4.30±0.65) points was significantly higher than that in group B (4.28±0.63) points (P<0.05). The satisfaction with surgical field of group A was better than that of group C (4.42±0.64) points, the difference was statistically significant (P<0.05). There was no significant difference in satisfaction wi points h surgical field between group B and group C (P>0.05). There was no significant difference in the incidence of postoperative complications among the three groups (P>0.05). The paw and PetCO₂ of T1, T2 and T3 in the three groups were significantly different from that of the same group of T0 (P<0.05). The paw and PetCO₂ of T1, T2 and T3 in group B and C were significantly different from those in group A (P<0.05). There was no significant difference in other indexes (P>0.05). ConclusionFor some elderly patients with poor cardiopulmonary function such as chronic bronchiolitis and emphysema, TEP with 6 mmHg low abdominal pressure can definitely reduce the intraoperative airway pressure and end respiratory PaCO₂, and increase the safety and tolerance of the operation. Although it slightly affects the operation field and space, it does not affect the smooth completion of the operation, and the incidence of postoperative complications and discharge time are not significantly affected.