CAJ | 학술논문

目的研究非气腹腹腔镜胆囊切除手术中影响手术操作空间的相关因素.探讨非气腹腹腔镜手术的应用规范.方法总结2007年3月- 2010年7月沧州中西医结合医院完成的49例非气腹腹腔镜胆囊切除术患者的临床资料.分析体重指数、肠道准备情况、麻醉方式等因素对手术时间、手术中转气腹率的影响.结果体重指数≤25的患者手术时间为(43.0±5.4) min,中转气腹率为0(0/34),体重指数＞25的患者手术时间为(52.8土7.4)min,中转气腹率为26.67％ (4/15),明显高于体重指数小于25的患者；进行肠道准备的患者手术时间为(44.5土5.4)min,中转气腹率为7.69％(2/26),术前没有进行肠道准备的患者手术时间为(46.1 ±8.0)min,中转气腹率为8.70％ (2/23)；采用硬膜外麻醉的患者手术时间为(46.5±7.9) min,中转气腹率为8.33％(2/24),腰麻加硬膜外联合麻醉的患者手术时间(44.1±6.8) min,中转气腹率为8.00％(2/25).结论非气腹腹腔镜胆囊切除术手术操作空间容易受到体重指数等因素的影响,准确评价患者的自身状况,合理选择手术方式、麻醉方式、恰当应用肠道准备,可以更好地发挥非气腹腹腔镜手术的优势.
목적 연구비기복복강경담낭절제수술중영향수술조작공간적상관인소.탐토비기복복강경수술적응용규범.방법 총결2007년3월- 2010년7월창주중서의결합의원완성적49례비기복복강경담낭절제술환자적림상자료.분석체중지수、장도준비정황、마취방식등인소대수술시간、수술중전기복솔적영향.결과 체중지수≤25적환자수술시간위(43.0±5.4) min,중전기복솔위0(0/34),체중지수＞25적환자수술시간위(52.8토7.4)min,중전기복솔위26.67％ (4/15),명현고우체중지수소우25적환자；진행장도준비적환자수술시간위(44.5토5.4)min,중전기복솔위7.69％(2/26),술전몰유진행장도준비적환자수술시간위(46.1 ±8.0)min,중전기복솔위8.70％ (2/23)；채용경막외마취적환자수술시간위(46.5±7.9) min,중전기복솔위8.33％(2/24),요마가경막외연합마취적환자수술시간(44.1±6.8) min,중전기복솔위8.00％(2/25).결론 비기복복강경담낭절제술수술조작공간용역수도체중지수등인소적영향,준학평개환자적자신상황,합리선택수술방식、마취방식、흡당응용장도준비,가이경호지발휘비기복복강경수술적우세.
Objective To investigate the potential factors which have impact on the working space for surgeons in gasless laparoscopic cholecystectomy and to probe into the specifications of gasless surgeries.Methods Clinical data of 49 cases of gasless laparoscopic cholecystectomy between March 2007 and July 2010 were summarized.The impacts of body mass index,bowel preparation and means of anesthesia on operation time and conversion to laparotomy were analyzed.Results For patients with body mass index ≤25and ＞ 25,operation times were (43.0 ± 5.4) min,and (52.8 ± 7.4 ) min,respectively,and rates of conversion to laparotomy were 0/34 and 4/15,respectively.Both indices in the first group were higher.For patients with and without bowel preparation,operation times were (44.5 ± 5.4) min and (46.1 ± 8.0)min,respectively,and rates of conversion to laparotomy were 2/26 and 2/23,respectively.For patients with epidural anesthesia and lumbar/epidural anesthesia,operation times were (46.5 ± 7.9) min and (44.1 ±6.8) min,respectively,and rates of conversion to laparotomy were 2/24 and 2/25,respectively.Conclusions The operation time of gasless laparoscopic cholecystectomy could be affected by many factors,such as body mass index.Gasless operations can be improved by evaluating the conditions of patients correctly and by selecting suitable operation methods,anesthesia means and bowel preparation.