河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (12): 1412-1416.doi: 10.3969/j.issn.1007-3205.2022.12.009

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LC中不同气腹压对急性结石性胆囊炎患者并发症发生率及内皮细胞损伤因子的影响

  

  1. 1.山西省大同市第五人民医院微创外科，山西 大同 037006；2.山西省大同市第五人民医院检验科，山西 大同 037006

  • 出版日期:2022-12-25 发布日期:2023-01-11
  • 作者简介:卫来燕（1984-），男，山西大同人，山西省大同市第五人民医院主治医师，医学硕士，从事微创外科诊治研究。
  • 基金资助:
    山西省卫生健康委科研课题（2020X1354）

Effects of different pneumoperitoneal pressures in LC on the incidence of complications and endothelial cell damage-related factors in patients with acute calculous cholecystitis

  1. Datong City, Shanxi 
    Province, Datong 037006, China; 2.Department of Laboratory, the Fifth People′s Hospital of 
    Datong City, Shanxi Province, Datong 037006, China
  • Online:2022-12-25 Published:2023-01-11

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摘要： 目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中不同气腹压对急性结石性胆囊炎（acute calculous cholecystitis，ACC）患者的影响。
方法 选取我院收治的ACC患者60例为研究对象，采用随机数字表法分为观察组和对照组，各30例。2组均行LC治疗，对照组术中维持常规气腹压（12~15 mmHg），观察组术中维持低气腹压（7~8 mmHg）。比较2组围术期指标、术后疼痛程度、并发症发生率，术前及术后24 h对两组肝功能及内皮细胞损伤相关因子进行检测对比。
结果 观察组首次排气时间、首次进食时间短于对照组（P＜0.05）；观察组术后1~24 h疼痛程度均低于对照组（P＜0.05）；术后24 h 2组丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、γ-谷氨酰转移酶、血管性假血友病因子、血栓调节蛋白、内皮素1均升高，但观察组低于对照组（P＜0.05）；观察组并发症发生率与对照组比较，差异无统计学意义（P＞0.05）。
结论 LC术中维持低气腹压在术野清晰度、疗效、安全性方面与正常气腹压效果相当，且有助于促进患者术后胃肠功能恢复，减轻术后疼痛程度，对保护肝功能及抑制内皮细胞损伤具有积极作用。


关键词: 胆囊炎, 急性, 胆囊切除术, 腹腔镜, 内皮细胞损伤

Abstract: Objective To investigate the effect of different pneumoperitoneal pressures in patients with acute calculous cholecystitis (ACC) during laparoscopic cholecystectomy (LC). 
Methods A total of 60 ACC patients admitted to our hospital were selected as the research subjects, and they were divided into the observation group (n=30) and the control group (n=30) by random number table method. Both groups were treated with LC. The control group maintained conventional pneumoperitoneal pressure (12-15mmHg) during operation, while the observation group maintained low pneumoperitoneal pressure (7-8 mmHg). The perioperative indicators, postoperative pain severity, and complication rate were compared between two groups. Before operation and at 24 h after operation, the liver function and endothelial cell damage-related factors were detected and compared between two groups. 
Results The first anal exhaust time and the first time of food intake in the observation group were shorter than those in the control group (P＜0.05). The pain severity in the observation group at 1 h-24 h after operation was lower than that in the control group (P＜0.05). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin(TBIL), gamma-glutamyl transferase (GGT), von Willebrand factor (vWF) , thrombomodulin (TM), and endothelin-1 (ET-1) increased in the two groups at 24 h after operation, but the above indexes in the observation group were lower than those in the control group(P＜0.05). There was no significant difference in the incidence of complications between the observation group and the control group (P＞0.05). 
Conclusion Maintaining low pneumoperitoneal pressure during LC surgery is equivalent to normal pneumoperitoneal pressure in terms of operative field clarity, efficacy, and safety, and it helps to promote recovery of postoperative gastrointestinal function, reduce postoperative pain, and has a positive effect on protecting liver function and inhibiting endothelial cell damage. 


Key words: cholecystitis, acute, cholecystectomy, laparoscopic, endothelial cell damage

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