无气腹腔镜与CO2气腹腹腔镜对精索静脉曲张患者围手术期的影响

目的 总结分析无气腹腔镜与CO₂气腹腹腔镜技术治疗精索静脉曲张的方法，对比分析不同方法血流动力学变化，患者围手术期的不同变化。 方法 对40例精索静脉曲张患者(均为左侧)，按照入院先后顺序随机分为无气腹腔镜组(实验组)及CO₂气腹腹腔镜组(对照组)，每组20例患者。均行单孔腹腔镜下行精索内静脉高位结扎术。比较2组患者的围手术期变化，包括检测2组患者麻醉开始前(T1)、悬架或气腹建立后30 min(T2)和悬架或气腹撤除后10 min(T3)3个时间点的平均动脉压、中心静脉压、心率、血氧饱和度、pH值和动脉血CO₂分压(PaCO₂)水平，观察患者术后变化。 结果 40例患者均手术成功，实验组术后肠鸣音恢复时间短、恶心呕吐发生率低，与对照组比较，差异有统计学意义(P＜0.05)，在T2时间点上，实验组中心静脉压、PaCO₂水平均低于对照组，2组对比差异有统计学意义(P＜0.05)。 结论 无气腹腔镜技术治疗精索静脉曲张是更安全可行的，对维持患者手术期间生命体征的平稳有积极作用，同时具有手术切口小、恢复快、术后瘢痕隐蔽等优点。CO₂气腹腹腔镜组术后肠鸣音恢复时间较长，恶心呕吐发生率较高，无气腹腔镜手术没有CO₂对患者的血流动力学及机体内环境的影响。 

Peri-operative Influences of gasless and CO2 pneumoperitoneum laparoscopy no patients with varicocele

Objective To analyze the treatment method of gasless laparoscopic and CO₂ pneumoperitoneum laparoscopic varicocele,compare the of hemodynamic changes and perioperative variations of different methods. Methods The 40 cases of varicocele patients (all the left) were divided into gasless group and CO₂ pneumoperitoneum group according to the order of admission time randomly,and there were 20 patients in each group.All patients were given High-level ligation of spermatic vein;Comparison of per-operative changes were done between gasless group and CO₂ pneumoperitoneum laparoscopic group,including detection of two groups of patients before the start of anesthesia(T1),suspension or gas after the abdomen after the establishment of 30 min(T2) and the suspension or removal of pneumoperitoneum 10 min(T3) and mean arterial pressure of three time-point,central venous pressure,heart rate,oxygen saturation,PH value, arterial pressure of CO₂(PaCO₂) level,and post-operative changes. Results Surgery of 40 patients were successful,the time of bowel function recovery,the incidence of nausea and vomiting between the two groups were statistically significant differences(P＜0.05),and the central venous pressure in the experimental group,PaCO₂ levels were points in time T2 the difference were statistically significant differences (P＜0.05). Conclusions Gasless laparoscopic technique is a safe and feasible method for treatment of varicocele,and easy to maintain stabilization of patient’s vital signs during operative time,and also have advantages of small incision,quick recovery,scar hidden.CO₂ pneumoperitoneum group was gurgling sound recovery time is longer,higher incidence of nausea and vomiting,no hemodynamics and internal environment of the patient’s blood vessel CO₂ gasless laparoscopic surgery.