王坤+张新伟+王培民

【摘要】目的探討不同CO2气腹压对腹腔镜老年结直肠癌手术患者下肢静脉回流的影响，为老年结直肠癌腹腔镜手术患者的治疗提供参考。方法收集老年结直肠癌腹腔镜手术患者63 例，根据不同气腹压将患者分为：低气腹压组（8 mmHg CO2）20 例、中气腹压组（12 mmHg CO2）24 例、高气腹压组（16 mmHg CO2）19 例。比较各组气腹建立前（T1）、气腹设定压力14 mmHg并维持20 分钟时（T2）、气腹消除后20分钟时（T3）的股静脉直径、血管血流、血流量及术后下肢静脉血栓形成情况。结果T2时，中气腹压组、高气腹压组股静脉直径较低气腹压组增大，血流速度、血流量较低气腹压组降低（P<0.05）；高气腹压组股静脉直径较中气腹压组增大，血流速度、血流量较中气腹压组降低（P<0.05）。T3时，高气腹压组股静脉直径较低气腹压组、中气腹压组增大，血流速度、血流量较低气腹压组、中气腹压组降低（P<0.05）。结论在确保手术术野清晰，不影响手术操作的情况下，尽可能降低CO2气腹压，而维持气腹压在12 mmHg较为合适。

【关键词】CO2气腹压； 腹腔镜；结直肠癌

中图分类号：R574.63 文献标识码：ADOI：10.3969/j.issn.1003-1383.2017.04.021

【Abstract】ObjectiveTo investigate the effects of different CO2 pneumoperitoneum pressures on lower extremity venous reflux in elderly patients with colorectal cancer undergoing laparoscopic surgery，so as to provide reference for treating elderly patients with colorectal cancer.Methods63 elderly patients with laparoscopic surgery for colorectal cancer were collected，according to different pneumoperitoneum pressures，they were divided into low pneumoperitoneum pressure group（8 mmHg CO2）（n=20），middle pneumoperitoneum pressure group（12 mmHg CO2）（n=24） and high pneumoperitoneum pressure group（16 mmHg CO2）（n=19）.Femoral venous diameter，vascular blood flow and blood flow volume at T1（before establishment of pneumoperitoneum），T2（setting of pneumoperitoneum pressure of 14 mmHg and maintaining for 20 minutes）and T3（20 minutes after elimination of pneumoperitoneum）and postoperative lower extremity venous thrombosis were compared between the two groups.ResultsAt T2，the femoral venous diameters in the middle pneumoperitoneum pressure group and the high pneumoperitoneum pressure group were significantly larger than that in the lower pneumoperitoneum pressure group，while the blood flow velocity and blood flow volume were significantly lower than those in lower pneumoperitoneum pressure group（P<0.05）；the femoral venous diameter in the high pneumoperitoneum pressure group was significantly larger than that in the middle pneumoperitoneum pressure group，and the blood flow velocity and blood flow volume were significantly lower（P<0.05）.At T3，the femoral venous diameter in the high pneumoperitoneum pressure group was significantly larger than those in low pneumoperitoneum pressure group and middle pneumoperitoneum pressure group，and the blood flow velocity and blood flow volume were significantly lower than those in the low pneumoperitoneum pressure group and the middle pneumoperitoneum pressure group（P<0.05）.ConclusionUnder the conditions of ensuring the operation field clear and without affecting the operation，CO2 pneumoperitoneum pressure should be reduced as much as possible，and it is more appropriate to maintain it at 12 mmHg.endprint

【Key words】CO2 pneumoperitoneum pressure；laparoscopy；colorectal cancer

近年来，随着结直肠癌发病率的增加，腹腔镜手术已成为结直肠癌治疗的首选。腹腔镜结直肠癌手术主要通过CO2气腹来获得手术操作空间，然而CO2气腹压会对患者的下肢静脉回流造成一定程度的影响，严重者可引起血栓形成，尤其是老年患者，血管弹性减弱、血管阻力增加等因素会增加下肢静脉血栓形成的风险[1]。因此，了解不同CO2气腹压对老年结直肠手术患者下肢静脉回流的影响，为临床此类手术患者选择合适的气腹压具有一定的临床意义。笔者对60例老年结直肠癌患者采用不同CO2气腹压腹腔镜切除术治疗，术中对患者的下肢静脉血流进行分析，以探讨不同CO2气腹压对老年患者下肢静脉回流的影响，现报道如下。

1对象与方法

1.1研究对象收集2014年1月至2015年12月在河南省新乡市第一人民医院普外科住院治疗的老年结直肠癌患者63 例，均择期行腹腔镜手术治疗。……