【摘要】目的 探讨心功能Ⅱ级患者在低气腹压下行腹腔镜胆囊切除术的可能性。 方法 总结我院2003年7月至2004年7月间收治的18例心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术的临床资料。 结果 18例心功能Ⅱ级患者中17例完成腹腔镜胆囊切除，1例中转开腹。 结论 心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术是可行的。
【摘要】 目的 研究不同压力二氧化碳（CO2）气腹对糖代谢的影响。 方法 18只雌性健康新西兰大白兔按CO2气腹压力随机均分为气腹压0 mm Hg （1 mm Hg=0.133 kPa）（Ⅰ组）、气腹压10 mm Hg（Ⅱ组）和气腹压15 mm Hg（Ⅲ组）。每组兔均在不同的压力下接受气腹1 h。在CO2气腹前（T0）、气腹后30 min （T1）、气腹后60 min （T2） 测定动脉血气分析值、血糖（Glu）、胰岛素（Ins）和胰高糖素（Gln）。 结果 气腹后30 min 、60 min，Ⅱ组与Ⅰ组比较，PaCO2、Glu 、Gln增加（Plt;0.05），pH值和Ins下降（Plt;0.05），Ⅲ组各参数变化更为显著（Plt;0.01）。结论 CO2气腹后机体可能处于较强烈的应激状态，导致血糖升高。【Abstract】 Objective To study effects of different intraabdominal pressure of carbon dioxide (CO2) pneumoperitoneum on blood glucose level in rabbits. Methods Eighteen female healthy rabbits weighed 2.1-3.3 kg were randomly divided into three groups equally based on pneumoperitoneum pressure: 0 mm Hg (1 mm Hg=0.133 kPa) group (groupⅠ),10 mm Hg group (groupⅡ) and 15 mm Hg (groupⅢ). Each group received 1h pneumoperitoneum under diffent pressure. Blood samples were taken before CO2 pneumoperitoneum, at 30 and 60 minutes after pneumoperitoneum for the measure-ments of arterial blood gas, blood glucose (Glu), insulin (Ins) and glucone (Gln). Results After pneumoperitoneum at 30 and 60 minutes, compared with groupⅠ, PaCO2,Glu and Gln were significantly raised in groupⅡ(Plt;0.05), pH and Ins were markedly decreased (Plt;0.05). Even more significant changes were observed in group Ⅲ(Plt;0.01). Conclusion After CO2 pneumoperitoneum, body is in a relatively b stress, so blood glucose is decreased.
自1987年Mouret完成世界首例腹腔镜胆囊切除术以来，随着外科医生手术技术的不断提高和腹腔镜器械的逐渐改进，腹腔镜微创技术的应用范围越来越广泛，以腹腔镜为代表的微创外科已经成为21世纪外科发展的方向之一，其对胃肠道恶性肿瘤根治的可行性和手术安全性已经得到认可。已有多项RCT研究显示，腹腔镜结直肠癌手术与开腹手术具有相当的近、远期疗效，美国结直肠癌外科医师协会已将其列为治疗结直肠癌的标准手术方式之一。近年来，腹腔镜在胃癌根治术中的应用已逐渐由早期胃癌扩展到进展期胃癌，并取得了与开腹手术相当的近、中期疗效。但是人们对CO2 气腹是否有利于胃肠道肿瘤的侵袭、转移一直心存疑虑，随之一些有关腹腔镜技术中不同种类、不同压力的气腹与胃肠道肿瘤侵袭、转移关系的研究报道相继出现,不同学者报道结果有较大差异，有些学者认为CO2气腹有利于胃肠道肿瘤的侵袭、转移; 而有些学者却认为CO2气腹对胃肠道肿瘤的侵袭、转移无显著影响。..................
【Abstract】ObjectiveTo investigate the effects of CO2 pneumoperitoneum on blood flow of carotid arteries in atherosclerosis rabbits.MethodsFifty Japan white rabbits were randomly divided into control group and three atherosclerosis groups. In atherosclerosis group, the rabbits were randomly subjected to CO2 pneumoperitoneum with an intraabdominal pressure of 0 mm Hg, 10 mm Hg or 15 mm Hg for 2 hours, after the model were created by feeding the rabbits with high fatty diet. The blood flow of the common carotid arteries were measured by electromagnetic blood flowmeter. Artery blood samples were collected for blood gas analysis at 30 minute intervals. ResultsHigher insufflation pressures and longer duration of CO2 pneumoperitoneum were associated with greater increase in blood flow of common carotid arteries. Compared with those in control group and atherosclerosis group with 0 mm Hg CO2 pneumoperitoneum, there were statistically significant increases in blood flow of the common carotid arteries during CO2 pneumoperitoneum in 10 mm Hg and 15 mm Hg pneumoperitoneum group, the changes in 15 mm Hg pneumoperitoneum group were more significant than those in 10 mm Hg pneumoperitoneum group (Plt;0.05). When compared with the blood flow before insufflation, those in 10 mm Hg and 15 mm Hg pneumoperitoneum group also increased significantly during CO2 pneumoperitoneum, even at 30 minute after desufflation (Plt;0.05). However, those in control group and 0 mm Hg pneumoperitoneum group did not change significantly (Pgt;0.05). There were significant decrease in pH and significant increase in PCO2 in both 10 mm Hg and 15 mm Hg groups, when compared with presufflation values or those in control group and 0 mm Hg pneumoperitoneum group(Plt;0.05). The changes in pH and PCO2, however, were no significant at any time point in control group and 0 mm Hg pneumoperitoneum group (Pgt;0.05). HCO3- did not change significantly in either group(Pgt;0.05).ConclusionUnder atherosclerosis conditions, CO2 pneumoperitoneum has an adverse influence on the blood flow of the common carotid arteries which may be associated with increased intrabdominal pressure,absorbed CO2 gas.
目的 评价舒芬太尼复合艾司洛尔对腹腔镜胆囊切除术二氧化碳气腹期间心血管反应和脑电双频指数（BIS）的影响。 方法 2010年1月－2011年12月间，选择美国麻醉医师协会分级Ⅰ～Ⅱ级择期腹腔镜胆囊切除术患者90例，随机分为芬太尼组（A组）、舒芬太尼组(B组）和舒芬太尼+艾司洛尔组（C组）。A组用芬太尼4 μg/kg，B、C组用舒芬太尼0.6 μg/kg麻醉诱导后气管插管，机械通气；C组在气腹前加用艾司洛尔。3组均常规静脉注射咪达唑仑0.1 mg/kg、丙泊酚2 mg/kg和维库溴铵0.1 mg/kg。分别记录各组在气腹前（T1）、气腹30 s（T2）、气腹5 min（T3）、气腹15 min（T4）时的收缩压、舒张压、平均动脉压、心率、血氧饱和度和BIS值。 结果 T1时C组收缩压、舒张压、心率、BIS值最低，各组间差异无统计学意义（P＞0.05）；T2、T3、T4时A组收缩压、舒张压、心率、BIS明显增加，B组有所上升，ⅢC组各时段变化不明显。A组与B组、B组与C组间差异有统计学意义（P＜0.05）。 结论 舒芬太尼复合艾司洛尔能更好地预防腹腔镜胆囊切除术二氧化碳气腹期间心血管反应和抑制BIS的增加。
Objective To examine the effects of carbon dioxide (CO2) pneumoperitoneum on local pancreas pathological changes, serum levels of amylase, IL-1, IL-6, and the positive rate of dissolubility adhesion molecule (CD11a/CD18 and CD11b/CD18) expression in rats with severe acute pancreatitis (SAP). Methods Fifty healthy male SpragueDawley (SD) rats were randomly divided into 3 groups: CO2 pneumoperitoneum group (n=20): SAP was induced by injecting 5% sodium taurocholate through retrogradely common biliopancreatic ducts via duodenal papilla， and then CO2 pneumoperitoneum was established at a pressure of 12 mm Hg (1 mm Hg=0.133 kPa) for 30 min; SAP group (n=20): The rats were treated as same as CO2 pneumoperitoneum group, except CO2 pneumoperitoneum； Simple operation group (n=10): Laparotomy was performed and nothing was done to duodenum and pancreas except for moving them softly. The blood samples were collected for examining serum levels of amylase, IL-1, IL-6, and the positive rates of CD11a/CD18 and CD11b/CD18 expression, and histopathologic examination of pancreas was performed. Results Compared with simple operation group, the pancreatic pathologic histology score, serum levels of amylase, IL-1, IL-6, and the positive rates of CD11a/CD18 and CD11b/CD18 expression were significantly higher in CO2 pneumoperitoneum group and SAP group (P=0.000). The levels of IL-1 and IL-6 were significantly lower in CO2 pneumoperitoneum group as compared to SAP group (P=0.000). There was no significant difference between CO2 pneumoperitoneum group and SAP group in pancreatic pathologic histology score (P=0.294), the level of serum amylase (P=0.073), the positive rates of CD11a/CD18 (P=0.155) and CD11b/CD18 expression (P=0.201). Conclusion CO2 pneumoperitoneum has inhibitory effect on the levels of IL-1 and IL-6, rather than the positive rates of CD11a/CD18 and CD11b/CD18 expression in SD rats with SAP.
Objective To investigate the way of closed establishment of pneumoperitoneum（CEPP） in patients with peritoneal cavity adhesion in laparoscopy, and to sum up the successful experience and the lesson of visceral injury. Methods CEPP experiences of 1 046 cases of peritoneal adhesion were retrospective analysed in 6 600 cases laparoscopy in our unit from September 1991 to September 1999.The difficulty of establishment of pneumoperitoneum was classified as real difficulty in establishment of pneumoperitonum (RDEPP) and false difficulty in establishment of pneumoperitonum (FDEPPD). RDEPP was due to Veress needle penetrating into viscera or peritoneal extensive adhesion in peritoneal cavity, and CO2 air flowing into difficulty. FDEPP was due to veress needle penetrating into extraperitoneum fat, round hepatic ligament or larger messentry. The formal situation required conversion to open laparotomy, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle direction or penetrating depth in second penetration. Results In this group 1 046 patients, 1 028 cases (98.3%) had been established pneumoperitoneum successfully by way of CEPP, 6 cases of RDEPP and 12 cases of FDEPP required open laparotomy. No complication related to CEPP had been found in this group except two cases visceral injury cured by laparotomy and repairment. Conclusion CEPP in patients with peritoneal adhesion is safe and feasible in laparoscopy. The main reason of CEPP failure is regarding FDEPP as RDEPP due to deficiency of experience and confidence of laparoscopist.
Objective To study the effects of different carbon dioxide pneumoperitoneum pressure and time on abdominal cavity infection bacteria of peritonitis in rats, including bacteria growth and bacterial translocation. Methods Sixty Sprague Dawley rats were injected with Eseherichia coli into the abdominal cavity to establish models of intra-abdominal infection. To give 3 types of pneumoperitoneum pressure for the experimental group: 15 mm Hg (1 mm Hg=0.133 kPa) for high pressure group, 5 mm Hg for low pressure group, and blank control group for no-pneumoperitoneum. To give 2 types of experimental period: 1 h and 3 h. These 60 Sprague Dawley rats were randomly divided intomoperi 6 groups by random number table. They were treated by different pneumoperitoneum pressure and time. All rats were killed at the end of the carbon-dioxide pneumo-peritoneum experiment. Peritoneal lavage fluids and portal vein blood were taken for microbiological examinations and culture. The endotoxin content in portal vein blood was detected too. Results ① Bacteria content: bacteria counts of different pneumoperitoneum pressure groups were obviously different (F=9.02, P=0.020), bacteria counts of different experimental period groups were obviously different (F=8.47, P=0.003), the effect of time was different in different pneumoperitoneum pressure groups (F=8.07, P=0.020). ② Bacterial translocation: Bacterial translocation occurred in all 6 groups. Blood culture positive rates were similar between 1 h group and 3 h group at 3 types of pneumoperitoneum pressure groups (P>0.05). The positive rate of blood culture in high pneumoperitoneum group was significantly higher compared with the no-pneumoperitoneum group (P<0.05). ③ The endotoxin content: the endotoxin content of different pneumoperitoneum pressure groups were obviously different (F=14.70, P<0.01), the endotoxin content in plasma increased obviously in high pressure group compared with low pressure group (P=0.018) and no-pneumoperitoneum group (P<0.01), the endotoxin content in plasma increased obviously in low pressure group compared with no-pneumoperitoneum group (P=0.005). The endotoxin content of different experimental period groups were obviously different (F=148.90, P<0.01), the endotoxin content in plasma increased obviously in 3 h group compared with 1 h group. There were no significant difference in the effect of time with different pneumoperitoneum pressure groups (F=0.14, P=0.874). Conclusion CO2pneumoperitoneum promoted intestinal bacterial endotoxin and bacterial translocation in peritonitis of rats, which increased with the pressure and time.
Objective To investigate the effect of CO2 pneumoperitoneum on the tumor cell port site implantation in laparoscopic surgery. Methods Male SpraqueDawley rats were intraperitoneally injected with gastric cancer cells (cell line SGC-7901). Continuous CO2 pneumo of 15 mm Hg or 30 mm Hg were established for 5 mins, 60 mins, 120 mins and 180 mins with the injection of different concentrations of tumor cells (104/ml, 106/ml respectively). Several samples of peritoneal washing served as positive control. All collecting dishes were incubated at 37℃ with 5% CO2 concentration for one week and then examined for the presence of tumor cell under microscope. Results After one week of incubation, some of the dishes with continuous flow of CO2 gas (5 L/min) at pneumo 30 mm Hg for 60 mins or longer demonstrated tumor growth, and all peritoneal washing samples showed tumor growth, while other dishes showed negative. Conclusion The research suggests that gastric cancer cells can cause port site implantation and the concentration of tumor cells, pneumoperitoneum pressure and duration may affect the occurrence of port site implantation. It may help to find a suitable way to prevent the port site implantation in operations.
Objective To study whether carbon dioxide used to establish pneumoperitoneum has an influence on port-site and intraperitoneal implantation and metastasis of tumor cells. Methods R15 hepatic cancer cells were injected into 30 Wistar rats’ peritoneal cavities 1 hour before operation, then the 30 Wistar rats were randomly divided into 3 groups: gasless group, helium group and carbon dioxide group. The suspension was exposed to the gas environment for 2 hours, all animals were killed after 28 days and the port-site and intraperitoneal implantation and metastasis of tumor cells were examined. Results On port-site, intestinal serous coat, mesentery, greater omentum and diaphragm, the weights of tumor cells, in carbon dioxide group were (326.7±230.3) mg， （626.2±215.9） mg，（476.2±204.8） mg，（2 536.5±906.7） mg and （384.5±149.9） mg respectively； in helium group were (235.6±107.3) mg， （414.2±148.4） mg, （261.8±92.6） mg, （1 633.4±247.3） mg and（220.0±57.9） mg； in gasless group were (145.0±42.4) mg， （221.5±108.2） mg， （212.5±109.6） mg, （797.5±335.9） mg and 113.0 mg.The weights of carbon dioxide group showed a significant increase, compared with helium group and gasless group (P＜0.05). The weights of helium group were greater than gasless group，but there was no significance in statistics (Pgt;0.05). Conclusion The insufflation of carbon dioxide promotes intraperitoneal tumor implantation and growth compared with helium and gaslessness in a rat model.