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Objective:To evaluate the influence of different CO2 pneumoperitoneum pressure on intestinal mucosal injury and intestinal function recovery in patients undergoing laparoscopic radical gastrectomy.Methods:A total of 120 patients undergoing laparoscopic radical gastrectomy were randomly divided into group A,B and C.Each group included 40 patients.CO2 pneumoperitoneum pressure ingroup A,B and C were 8～10 mmHg,11～13 mmHg and 14～16 mmHg,respectively.The degree of intestinal mucosa damage,plasma D-lactate(2,24 and 48 hours after the treat-ment),intestinal function recovery and complication ration were compared between the three groups.Results:Damage degree of intestinal mucosa after operation in A,B and C groups were 0～1,1～2 and 2～3 respectively.There was significant change in intestinal mucosa injury after operation in both B and C groups.The level of D-lactic acid in group C (2,24 and 48 hours after the treat-ment) were significantly higher those in group A and group B (P＜0.05).The bowel sounds appeared time,exhaust time and intake time in group C were significantly longer than group A and group B (P＜0.05).The incidence of complications were not significantly difference during the three groups.Conclusion:The high pressure of CO2 pneumoperitoneum will cause intestinal mucosa damaged,and not conducive to the patients' intestinal rehabilitation.We suggest that the CO2 pneumoperitoneum pressure should be as low as possible under clear visualization during operation.
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Objective To investigate the effect of different pressure CO2 pneumoperitoneum on function of liver and kidney in patients undergoing laparoscopic gastrectomy.Methods A total of sixty pa-tients,aged 40-65 years,scheduled for elective laparoscopic gastrectomy were randomly divided into three groups (n=20).The pressures of CO2 pneumoperitoneum were set at 6-8,9-11 and 12-14 mm Hg in group L,group M and group H respectively.The venous blood samples before pneumoperitoneum (T1 ),1 hour after pneumoperitoneum(T2 ),2 hour after pneumoperitoneum (T3 ),1 hour(T4 )and 24 hours(T5 )after stopping pneumoperitoneum were collected for determination of serum concentrations of NAG,Cys-C, ALT,AST,Cr,BUN and the amount of urine.pH,PaCO2 ,PaO2 were recorded at T1-T4 .Results ALT, AST,Cr and BUN were not different at T1-T5 in the three groups.Compared with group L,the concentra-tion of NAG and Cys-C at T2-T5 were significantly higher in the group M and H (P <0.05).Compared with group L,the amount of urine at T2-T5 was significantly lower in the group M and H (P <0.05 ), PaCO2 was significantly increased in the group H and M at T2-T4 (P <0.05).Conclusion The pressure of 6-8 mm Hg CO2 pneumoperitoneum can alleviate the damage of function of liver and kidney in patients un-dergoing laparoscopic gastrectomy.
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Objective To explore the appropriate pneumoperitoneum pressure in different surface area children during pediatric laparoscopic surgery,so as to attenuate the intederence with physiological function and avoid pneumoperitoneum correlative complications.Methods 120 patients underwent laparoscopic surgery were divided into three groups by different surface area:A(0.43～0.67m2),B(0.68～0.92m2),C(0.93～1.17m2).Each group was divided into two subgroups again by different pneumoperitoneum pressure:A1(4 mm Hg),A2(6mm Hg),B1(7mm Hg),B2(9mm Hg),C1(10mm Hg),C2(12 mm Hg).The cardiorespiratory function and blood gas analysis in different time point before and after pneumoperitoneum were monitored.Results The increase of PET CO2,Paw,HR,MAP and PaCO2 in A2,B2,C2 were more obvious than in A1,B1,C1(P ＜ 0.01).The eligible pneumoperitoneum pressure for A,B,C were 4,7,10mmHg respectively.The complications of gastric contents back-streaming and respiratory acidosis were 7 cases in A2,B2,C2 in all,and 3 cases in A1,B1,C1.Conclusion Using a compatible pneumoperitoneum pressure for different surface area children could attenuate the interference of physiological function and avoid pneumoperitoneum correlative complications.
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Objective To observe changes of cardiorespiratory function and blood gas analysis in different pneumoperitoneum pressure during age-specific pediatric laparoscopic surgery and to find a compatible pneumoperitoneum pressure for different age-specific children.Methods One hundred and fifty cases undergoing laparoscopic surgery were divided into three groups:A(1～3y),B(4～6y),C(7～12y).Each group was divided into two subgroups again by different pneumoperitoneum pressure:A1,A2,B1,B2,C1,C2.Monitoring the cardiorespiratory function and blood gas analysis in different time point before and after pneumoperitoneum.Results Compared with the baseline value,PETCO2,Paw,MAP,HR,PaCO2 significantly increased after peritoneal insufflation in each group.And the increase in A2,B2,C2 were more obvious than in A1,B1,C1 (P<0.05).The eligible pneumoperitoneum pressures for A,B,C were 9,11,13mm Hg respectively.Conclusion Using a compatible pneumoperitoneum pressure for different age-specific children can meet the requirement of operation and attenuate the interference with physiological function.
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0.05).Conclusions Epidural anesthesia and lower pneumoperitoneum pressure(8 mm Hg) can completely meet with demands of most LC operations,and have the advantages of safety,economy and minimal invasion.
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Objective To evaluate the effect of CO2 pneumoperitoneum with various pressures on the ultrastructure of the implanted lesions in rats model of endometriosis. Methods Endometriosis model was established in 30 SD rats by implanting self-endometria onto the peritoneum to form ectopic endometrial tissues. Then the animals were divided randomly into three groups (ten in each):control,10 mm Hg,and 20 mm Hg CO2 pneumoperitoneum groups (CO2 inflation lasted for 1 hour). One week after the procedure,the ectopic endometrial tissues were sampled for electron microscopy to determine the ultrastructure of cell organelle in the endometriosis glands and matrix cells. Results The electron microscopy showed that in the control group,the matrix cells lined up in order and the structure of the microvilli (MV) was normal; while in the 10 mm Hg and 20 mm Hg groups,the chromatin margination of glandular cells and mitochondria swelling were observed with reduced or vanished mitochondrial crista,the ultrastructural damages to the microvilli (reduced or vanished) were more apparent than the control,the cell junctions were widened or collapsed,and the matrix cells lined up disorderly. Compared to the 10 mm Hg group,ultrastructural damage to the glandular cells in the 20 mm Hg group was more severe. Conclusions CO2 pneumoperitoneum intervention can induce ultrastructural damage to endometriosis lesions. 20 mm Hg pressure of CO2 pneumoperitoneum can induce severer damage to the ectopic endometriosis tissues than 10 mm Hg.