不同气腹压力腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎患者对呼吸和肝肾功能的影响比较研究*

doi:10.3969/j.issn.1672-5069.2025.06.034

摘要/Abstract

摘要： 目的比较不同气腹压力下腹腔镜胆囊切除术(LC)治疗胆囊结石伴慢性胆囊炎患者对呼吸和肝肾功能的影响。方法 2021年4月～2025年4月我院收治的94例胆囊结石伴慢性胆囊炎患者,在接受LC手术时,被随机分为腹内压低压组47例和高压组47例,分别在术中维持气腹压8～12 mmHg和13～16 mmHg,完成手术。使用肺功能仪标准化用力呼气检测呼气峰流速(PEF)、用力肺活量(FVC)和中期呼气流量(FEF_25%~75%)。采用视觉模拟疼痛评分(VAS)评估疼痛。结果在术后1 d,腹内低压组PEF、FVC和FEF_25%~75%水平分别为(62.9±12.9)L、(71.4±13.5)L和(87.1±20.1)L/sec,均显著高于高压组【分别为(41.0±10.2)L、(46.8±11.5)L和(44.8±10.4)L/sec,P<0.05】;在术后3 d,低压组血清ALT和AST水平分别为(47.3±11.4)IU/L和(42.9±12.1)IU/L,均显著低于高压组【分别为(75.1±12.6)IU/L和(64.9±14.2)IU/L,P<0.05】;低压组血清BUN和sCr水平分别为(4.9±1.0)mmol/L和(90.1±10.3)μmol/L,均显著低于高压组【分别为(5.5±1.1)mmol/L和(97.1±11.2)μmol/L,P<0.05】;低压组术后肠鸣音恢复时间、肛门排气时间和首次排便时间分别为(13.5±2.3)h、(18.9±4.9)h和(27.4±7.4)h,均显著短于高压组【分别为(18.7±3.6)h、(25.8±5.3)h和(42.1±8.5)h,P<0.05】;术后低压组肩痛发生率为19.2%,显著低于高压组的45.2%(P<0.05)。结论在行LC术治疗胆囊结石伴慢性胆囊炎患者时,宜采取低压力气腹,在保证手术顺利完成的前提下,尽量减少对机体呼吸和肝肾功能的影响。

关键词: 胆囊结石, 慢性胆囊炎, 腹腔镜胆囊切除术, 气腹压力, 治疗

Abstract: Objective The aim of this study was to investigate the impact of different pneumoperitoneum pressures (PPP) on respiratory and hepato-renal functions in patients with cholecystolithiasis and chronic cholecystitis receiving laparoscopic cholecystectomy (LC). Methods 94 patients with cholecystolithiasis and chronic cholecystitis were enrolled in our hospital between April 2021 and April 2025, and all received LC surgery. During the operation, the patients were randomly divided into two groups, receiving low PPP (8-12 mmHg) in 47 cases and high PPP (13-16 mmHg) in another 47 cases. The peak expiratory flow (PEF), forced vital capacity (FVC) and mid-expiratory flow (FEF_25%-75%) were measured by standardized forced expiratory test. Pain was evaluated by VAS. Results One day after operation, the PEF, FVC and FEF_25%~75% in low PPP group were (62.9±12.9) L, (71.4±13.5)L and (87.1±20.1)L/sec, all much higher than [(41.0±10.2)L, (46.8±11.5)L and (44.8±10.4)L/sec, respectively, P<0.05] in high PPP group; by end of three days after surgery, serum ALT and AST levels in low PPP group were (47.3±11.4)IU/L and (42.9±12.1)IU/L, both much lower than [(75.1±12.6)IU/L and (64.9±14.2)IU/L, respectively, P<0.05] in high PPP group; serum BUN and Cr levels were (4.9±1.0)mmol/L and (90.1±10.3)μmol/L, both significantly lower than [(5.5±1.1)mmol/L and (97.1±11.2)μmol/L, respectively P<0.05] in high PPP group; postoperative bowel sound recovery, anal exhaust and first defecation time in low PPP group were(13.5±2.3) h, (18.9±4.9) h and (27.4±7.4) h, all much shorter than [(18.7±3.6)h, (25.8±5.3)h and (42.1±8.5)h, respectively, P<0.05] in high PPP group; the incidence rate of postoperative shoulder pain in low PPP group was 19.2%, much lower than 45.2%(P<0.05) in high PPP group. Conclusion We recommend relative low pneumoperitoneum pressure at 8-12 mmHg during LC operation in patients with cholecystolithiasis and chronic cholecystitis, which might influence less respiratory and hepato-renal functions.

Key words: Cholecystolithiasis, Chronic cholecystitis, Laparoscopic cholecystectomy, Pneumoperitoneum pressure, Therapy

王卿, 涂小磊, 侯佳佳. 不同气腹压力腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎患者对呼吸和肝肾功能的影响比较研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 934-937.

Wang Qing, Tu Xiaolei, Hou Jiajia. Influence of different pneumoperitoneum pressures on respiratory and hepato-renal functions in patients with cholecystolithiasis and chronic cholecystitis receiving laparoscopic cholecystectomy[J]. Journal of Practical Hepatology, 2025, 28(6): 934-937.

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不同气腹压力腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎患者对呼吸和肝肾功能的影响比较研究^*

Influence of different pneumoperitoneum pressures on respiratory and hepato-renal functions in patients with cholecystolithiasis and chronic cholecystitis receiving laparoscopic cholecystectomy

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