【摘要】：目的急性胃腸損傷是指由于急性疾病本身導(dǎo)致的胃腸功能障礙。自從腹腔鏡技術(shù)及“快通道外科”理念廣泛應(yīng)用于臨床,結(jié)直腸切除術(shù)后急性胃腸損傷的發(fā)病率呈顯著下降。但是腹內(nèi)壓升高至12~15mm Hg引起的腹腔內(nèi)高壓可能會(huì)導(dǎo)致急性胃腸損傷的發(fā)生,目前尚不清楚腹腔鏡手術(shù)中腹內(nèi)壓升高與術(shù)后急性胃腸損傷之間的相關(guān)性。本研究旨在評(píng)估腹腔鏡結(jié)直腸手術(shù)中CO_2氣腹壓力升高對(duì)術(shù)后急性胃腸損傷的影響。方法66例接受結(jié)直腸癌手術(shù)的患者隨機(jī)平均分成3組,各組術(shù)中CO_2氣腹壓力分別設(shè)定為10mm Hg,12mm Hg和15mm Hg。術(shù)后記錄患者首次排氣/排便的時(shí)間、恢復(fù)腸蠕動(dòng)的時(shí)間、進(jìn)食半流質(zhì)的時(shí)間、嘔吐及腹瀉的出現(xiàn)情況用來(lái)評(píng)估急性胃腸損傷的發(fā)生及程度。同時(shí)在建立CO_2氣腹前及術(shù)后第一天測(cè)定患者血清內(nèi)白介素-6和腫瘤壞死因子-α的水平。結(jié)果本研究共納入41例男性和25例女性病例,平均年齡63.6歲,其中共15例(27.3%)出現(xiàn)急性胃腸損傷(除外11例符合退組標(biāo)準(zhǔn))。CO_2氣腹引起的腹內(nèi)壓增高并沒(méi)有增加急性胃腸損傷的發(fā)生率(X_2=2.04,p0.05),也沒(méi)有增加其嚴(yán)重程度(X_2=2.00,p0.05)。較低的腹內(nèi)壓力也沒(méi)有加速胃腸功能的恢復(fù)并縮短住院時(shí)間(X_2=0.90,p0.05)。術(shù)后白介素-6水平升高但與術(shù)中腹內(nèi)壓力無(wú)關(guān)(X_2=2.65,p0.05)。結(jié)論腹腔鏡結(jié)直腸手術(shù)后急性胃腸損傷的發(fā)生率與術(shù)中腹內(nèi)壓力升高無(wú)關(guān),腹腔鏡結(jié)直腸手術(shù)在腹腔內(nèi)壓力升高至15mm Hg以內(nèi)安全可行。
[Abstract]:Objective Acute gastrointestinal injury refers to gastrointestinal dysfunction caused by acute disease itself. Since laparoscopic techniques and the concept of "fast-track surgery" have been widely used in clinical practice, the incidence of acute gastrointestinal injury after colorectal resection has decreased significantly. However, intraperitoneal hypertension caused by elevated intraabdominal pressure to 12-15 mm Hg may lead to acute gastrointestinal dysfunction. The relationship between elevated intra-abdominal pressure and postoperative acute gastrointestinal injury in laparoscopic colorectal surgery is unclear. The aim of this study was to evaluate the effect of elevated CO_2 pneumoperitoneal pressure on postoperative acute gastrointestinal injury in laparoscopic colorectal surgery. Intraoperative CO_2 pneumoperitoneal pressure was set at 10 mm Hg, 12 mm Hg and 15 mm Hg. The time of first exhaust/defecation, the time of recovery of intestinal peristalsis, the time of eating semifluid, the occurrence of vomiting and diarrhea were recorded after operation to assess the occurrence and severity of acute gastrointestinal injury. Results A total of 41 male and 25 female patients with an average age of 63.6 years were enrolled in this study. Among them, 15 (27.3%) suffered from acute gastrointestinal injury (except 11 who met the criteria for withdrawal). Increased intra-abdominal pressure caused by CO_2 pneumoperitoneum did not increase the incidence of acute gastrointestinal injury (X_2=2.04). The lower intra-abdominal pressure did not accelerate the recovery of gastrointestinal function and shorten the hospital stay (X_2 = 0.90, P 0.05). The elevated level of interleukin-6 was not associated with intra-operative intra-abdominal pressure (X_2 = 2.65, P 0.05). Conclusion The incidence of acute gastrointestinal injury after laparoscopic colorectal surgery was related to intra-operative pressure. It is safe and feasible for laparoscopic colorectal surgery to increase the intraperitoneal pressure to less than 15 mm Hg.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R656

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