气腹与非气腹腹腔镜胆囊切除的随机对照研究

目的探讨腹壁悬吊式非气腹装置在腹腔镜手术中的应用价值。方法采用随机对照方法比较非气腹（n=37）与CO2气腹（n=38）腹腔镜胆囊切除术的手术时间、术中出血量、术后即时动脉血气分析、术后住院时间、术后第1天血ACTH变化及术后并发症情况。结果2组均顺利完成手术,气腹组手术时间（34.2±7.7）min显著短于非气腹组（46.7±16.8）min（t=-4.160,P=0.000）,气腹组术中出血量（10.4±2.0）ml显著少于非气腹组（14.8±7.2）ml（t=-3.627,P=0.000）。术后即时动脉血气分析、术后住院时间[气腹组为（3.7±0.7）d,非气腹组为（3.9±1.2）d,t=0.884,P=0.379）]和术后第1天ACTH（气腹组中位数为5.66pmol/L,非气腹组中位数为5.48pmol/L,Z=0.748,P=0.436）2组比较差异无统计学意义。术后2组均无严重并发症,非气腹组37例中有20例出现了右季肋部皮下气肿,气腹组无此并发症出现。结论腹壁悬吊式非气腹装置安全简单,患者术后恢复好,并可避免气腹手术的相关并发症,拓宽了腹腔镜手术的应用范围,具有在临床推广应用的价值。

Comparison of Gas and Gasless Laparoscopy Cholecystectomy: Randomized Controlled Study

Objective To explore the value of abdominal wall lifting devices in laparoscopic cholecystectomy. Methods Patients who were going to receive laparoscopic cholecystectomy were randomly divided into two groups： one group underwent pneumoperitoneum （ Gas group, n = 38） , the other group was treated with gasless technique using a subcutaneous abdominal wall lifting devices （ Gasless group, n = 37）. Parameters including operation time, blood loss, real-time results of arterial blood gas analysis, postoperative hospital stay, post-operative ACTH and complications were compared between the two groups. Results The operation was completed in both the groups. There existed significant difference in the mean operation time and blood loss between the two groups [ Gas group vs Gasless group： （34.2±7.7） min vs （46.7 ±16.8） min, t= -4. 160, P=0.000 and （10.4±2.0） mlvs （14.8 ±7.2） ml, t= -3.627, P = 0. 000]; whereas, no significant difference was found between the two in the real-time results of arterial blood gas analysis, postoperative hospital stay [ （3.7 ±0.7） d vs （3.9± 1.2） d, t =0. 884, P = 0. 379 ] and post-operative level of ACTH （5.66 pmol/L vs 5.48 pmol/L, Z = 0. 748, P = 0. 436）. No severe complications occurred in both the groups. In the gasless group, 20 of the 37 patients developed subcutaneous emphysema, while none of the Gas group showed the symptom. Conclusion Gasless abdominal wall lift device is safe and simple, resulting in quick recovery without leading to pneumoperitoneum-related complications.