【作者】 傅衍博；

【导师】 王磊； 胡三元；

【作者基本信息】 山东大学 ， 临床医学， 2010， 硕士

【摘要】 研究背景及目的经脐单孔腹腔镜操作技术是通过脐部这一人体唯一的瘢痕置入腹腔镜器械,进行腹腔镜手术,相比于经自然腔道外科手术(NOTES)的各种限制,经脐单孔腹腔镜手术是目前创伤最小,美容效果最好的微创手术。但由于CO2气腹存在各种特有并发症,如皮下气肿、气体栓塞、高碳酸血症、心律失常、气胸、纵膈气肿等,特别是对于有心肺功能障碍的病人或年龄较大的病人容易使心功能进一步恶化,悬吊式经脐单孔腹腔镜操作技术应运而生。本研究拟比较悬吊式经脐单孔腹腔镜操作技术与气腹经脐单孔腹腔镜操作技术的术中平均动脉压(MAP)、手术时间、术后恢复时间、SpO2、体重指数、手术费用、术中出血、并发症等方面,讨论悬吊式经脐单孔腹腔镜操作技术的可行性。研究方法查阅2008.11-2010.1收入山东大学齐鲁医院普外科由胡三元教授行气腹经脐单孔腹腔镜胆囊切除术和悬吊式经脐单孔腹腔镜胆囊切除术的患者的病案,术前已按照美国ASA标准,选取ASAⅠ、Ⅱ级的患者随机进行气腹经脐单孔腹腔镜手术和悬吊式经脐单孔腹腔镜手术。根据手术方式将患者分为两组：气腹经脐单孔腹腔镜术患者和悬吊式经脐单孔腹腔镜术患者。比较两组患者的术中平均动脉压(MAP)、手术时间、术后恢复时间、SpO2、体重指数、手术费用、术中出血、并发症。使用标准统计软件SPSS15.0进行数据处理,计量资料采用均数±标准差表示,采用完全随机两样本t检验,计数资料采用四格表法χ2检验,不符合正态分布的数据采用非参数检验中的秩和检验(P<0.05有统计学意义)。结果2008.11-2010.1年山东大学齐鲁医院普外科接受气腹经脐单孔腹腔镜胆囊切除术和悬吊式经脐单孔腹腔镜胆囊切除术的病人共28例,其中符合ASAⅠ、Ⅱ级标准的共24例。气腹组手术病人建立气腹后前15min内MAP增加明显(P<0.001),悬吊组MAP维持在基线水平；两组病人均属于ASAⅠ、Ⅱ级病人,术中及术后SpO2变化无明显统计学差异两组手术手术时间不具有统计学差异(P>0.05),虽然悬吊组手术野显露较气腹组差,但手术时间基本一致；术后恢复时间不具有统计学差异(P>0.05)；手术费用具有统计学差异(P<0.05),悬吊组手术费用较气腹组手术费用低；术中出血少,无明显统计学差异。结论及意义悬吊式经脐单孔腹腔镜手术因不需要二氧化碳气腹的建立,避免了气腹特有的并发症,适用于心肺功能不全者或老年患者。通过此研究,证明悬吊式经脐单孔腹腔镜操作技术在美容效果上与气腹经脐单孔腹腔镜操作技术一样,并且在血流动力学方面更稳定,术后恢复快,避免了一次性的耗材,降低了费用,在经济方面更具有优势。更多还原

【Abstract】 Background and Objective:The transumbilical single port pneumoperitoneum laparoscopic operation technology is the laparoscopic surgery with laparoscopic instruments through umbilicus.Compared by the natural orifice surgery (NOTES) in a variety of restrictions, the umbilical single port laparoscopic surgery is the minimally invasive surgery with minimal trauma and better cosmetic results。However, there is a variety of CO2 pneumoperitoneum specific complications such as subcutaneous emphysema, gas embolism, hypercapnia, arrhythmia, pneumothorax, pneumomediastinum and so on. Particularly determined to pulmonary dysfunction for older patients with cardiopulmonary dysfunction patients, suspended transumbilical single port laparoscopic operating techniques emerged. This study compared transumbilical single port pneumoperitoneum laparoscopic operation technology and suspended transumbilical single port laparascopic operation technology by the mean arterial pressure (MAP), operation time, recovery time, SpO2, body mass index, hospital costs, blood loss, complications and so on, to discuss the feasibility of the suspended trnsumbilical single port laparoscopic operation technology. Methods:The documents of the patients who had been admitted into the department of General Surgery of Qilu Hospital, and undergone transumbilical single port pneumoperitoneum laparoscopic and suspended trnsumbilical single port laparoscopic cholecystectomy by professor HU San-Yuan in the period of 2008 to January 2010 were reviewed, ASA standards by the United States before the operation, select ASAⅠ,Ⅱgrade were randomly carried out by single umbilical port pneumoperitoneum laparoscopic surgery and suspended transumbilical single port laparoscopic surgery. The patients were divided into two groups:The single umbilical port pneumoperitoneum laparoscopy patients and suspended transumbilical single port laparoscopic surgery patients. Two groups were compared, the mean arterial pressure (MAP), operation time, recovery time, SpO2, body mass index, hospital costs, blood loss, complications. The statistics is analysed by SPSS 15.0 software with the t test or Wilcoxon test andx2 test between groups (P<0.05).Results:In the period of November 2008 to January 2010, there were 28 paitents who accept transumbilical single port laparoscopic cholecystectomy and suspended transumbilical single port laparoscopic cholecystectomy, of which comply with ASAⅠ,Ⅱstandard of a total of 24 cases. Pneumoperitoneum group of surgical patients before, after establishing pneumoperitoneum MAP increased significantly within 15min (P＜0.001), suspension group MAP remained at baseline level; two surgical operating time was not statistically different (P> 0.05), although operational exposure is poor in the suspension group, but basically the same operation time; recovery time after surgery was not statistically different (P> 0.05); there is significantly different in hospital costs (P<0.05), suspension group surgical is lower to pneumoperitoneum group; there is no significant difference in body mass index; less bleeding, no significant statistical difference.Conclusions:Suspended transumbilical single port laparoscopic surgery does not require carbon dioxide for the establishment of pneumoperitoneum, avoid specific complications of pneumoperitoneum for elderly patients with cardiopulmonary dysfunction. Suspended operation by the umbilical single port laparoscopic technique is similar to the insufflation as umbilical single port laparoscopic operation techniques in cosmetic results, and better hemodynamic stability, rapid recovery,also there is advantage in economy by avoiding one-off consumables.更多还原