祝华义

【摘要】 目的 探討腹腔镜下肠道肿瘤切除患者气腹相关并发症， 并分析相应的对策。方法 分别选取2011年5月～2013年4月和2013年5月～2015年4月期间本院收治的腹腔镜下肠道肿瘤切除术患者各237例， 分别作为A组和B组。两组患者均行腹腔镜手术， A、B组患者气腹压力分别控制在14～19 mm Hg（1 mm Hg=0.133 kPa）和9～10 mm Hg。统计两组患者气腹相关并发症发生情况及各类气腹相关并发症发生情况。结果 B组发生气腹相关并发症106例， 发生率为44.73%， 其中肩部疼痛、恶心呕吐、高碳酸血症发生率分别为18.99%、25.74%、0；A组气腹相关并发症发生234例， 发生率为98.73%， 其中肩部疼痛、恶心呕吐、高碳酸血症发生率分别为40.93%、57.38%、0.42%；B组患者气腹相关并发症、肩部疼痛、恶心呕吐发生率明显低于A组， 差异具有统计学意义（P<0.05）。本研究474例患者共有340例患者出现气腹相关并发症， 发生率为71.73%， 其中以恶心呕吐最为常见， 发生197例， 占57.94%， 高碳酸血症发生率最低。结论 腹腔镜下肠道肿瘤切除患者可以发生多种并发症， 其中恶心呕吐、肩部疼痛发生率较高， 可以通过降低气腹压力进行预防；高碳酸血症等并发症发生几率较低， 但是也要通过适当方法进行预防， 以免引起严重后果。

【关键词】 腹腔镜；肠道肿瘤手术；气腹

DOI：10.14163/j.cnki.11-5547/r.2017.09.017

Analysis of pneumoperitoneum complications in laparoscopic intestinal tumor resection patients and research of countermeasures ZHU Hua-yi. Luocheng Mulao Autonomous County Peoples Hospital， Luocheng 546400， China

【Abstract】 Objective To investigate related pneumoperitoneum complications in laparoscopic intestinal tumor resection patients， and to analyze related countermeasures. Methods There were 237 patients during May 2011～April 2013 and 237 patients during May 2013～April 2015 in laparoscopic intestinal tumor resection respectively as group A and group B. Both groups received laparoscopic operation with controlled pneumoperitoneum pressure respectively at 14～19 mm Hg （1 mm Hg=0.133 kPa） and 9～10 mm Hg. Summary was made on related pneumoperitoneum complications and their occurrence condition in the two groups. Results There were 106 cases with related pneumoperitoneum complications in group B， with incidence as 44.73%. Incidences of shoulder pain， nausea and vomiting， and hypercapnia were respectively 18.99%， 25.74% and 0. There were 234 cases with related pneumoperitoneum complications in group A， with incidence as 98.73%. Incidences of shoulder pain， nausea and vomiting， and hypercapnia were respectively 40.93%， 57.38% and 0.42%. Group B had obviously lower incidence of related pneumoperitoneum complications， shoulder pain， nausea and emesis than group A， and their difference had statistical significance （P<0.05）. Among 474 patients in this research， there were totally 340 cases with related pneumoperitoneum complications， along with incidence as 71.73%. Nausea and vomiting is the most common complications in 197 cases， accounting for 57.94%， while hypercapnia showed the lowest incidence. Conclusion Laparoscopic intestinal tumor resection leads to various complications， especially with higher incidence of nausea and vomiting， and shoulder pain， and the complications can be prevented by lowering pneumoperitoneum pressure. Low incidences of hypercapnia also requires appropriate measures for prevention to avoid severe outcome.

【Key words】 Laparoscope； Intestinal tumor operation； Pneumoperitoneum

腹腔镜手术因创伤小、恢复快等优点而越来越被医患双方所接受， 其治疗效果也得到大量研究的证实， 广泛应用于肠道肿瘤患者的治疗中[1-6]。腹腔镜手术对腹腔内脏器的干扰较小， 但是由于手术过程中需要使用二氧化碳（CO2）建立气腹， 这个过程也有可能对脏器生理功能产生不良影响[7-12]。本研究回顾分析了474例腹腔镜下肠道肿瘤切除患者的临床资料， 对气腹相关并发症进行了分析， 并提出相应干预措施， 现报告如下。

1 资料与方法

1. 1 一般资料 分别选取2011年5月～2013年4月和2013年5月～2015年4月期间本院收治的腹腔镜下肠道肿瘤切除术患者各237例， 分别作为A组和B组。所有患者均由同一组医生進行手术。两组患者性别、年龄、肿瘤位置以及是否有肿瘤手术史和腹膜炎史等一般资料比较， 差异无统计学意义（P>0.05）， 具有可比性。……