中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (07): 591-593.

• 论著 • 上一篇    下一篇

腹腔镜结直肠癌根治术CO2气腹对下肢深静脉血流动力学影响的研究

王 瑜1a，王燕婷1a，蒋彦彦1b，林亚华2，邹忠东1a   

  1. 1南京军区福州总医院a.普通外科 b.超声诊断科，福建福州 350025；2南京军区福州总医院附属第二医院普通外科，福建宁德 352100
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-07-08 发布日期:2009-07-08

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-07-08 Published:2009-07-08

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摘要：

目的 探讨腹腔镜结直肠癌根治术CO2气腹及体位对下肢深静脉血流动力学的影响。方法 2007年8月至2008年6月，通过彩色多普勒对南京军区福州总医院30例腹腔镜结直肠癌根治术病人平卧位气腹前、不同CO2气腹压（6mmHg、8mmHg、10mmHg、12mmHg，1mmHg=0.133kPa）下及12mmHg CO2气腹建立后，取头低脚高位，测定手术前后股静脉直径、平均血流速度,血流量。结果 与气腹前相比，6mmHg CO2气腹建立后，股静脉血流动力学指标无显著变化，但CO2气腹压增至8mmHg后，随着气腹压的增加出现与压力呈显著正相关的股静脉直径增大、血流速度减慢、血流量减少。术中12mmHg CO2气腹建立后取头低脚高位时与平卧位比较股静脉直径显著减小，平均血流速度、血流量均显著增加，但达不到气腹前水平；至术毕气体排出前，股静脉直径基本恢复到平卧位气腹后水平，而平均血流速度、血流量仍高于平卧位气腹后水平，但显著低于气腹后头低脚高位时；术后气体排出后取平卧位，股静脉直径变小，但与气腹前相比仍显著增粗，而平均血流速度及血流量基本达到气腹形成前的水平。结论 腹腔镜结直肠癌根治术CO2气腹的建立可致与压力呈正相关的下肢静脉血液回流不畅，增加术后静脉血栓的风险，应尽量采用较低气腹压；而其特殊的头低脚高体位有利于血液的回流，可改善CO2气腹所致静脉血液回流不畅，但不能完全抵销其对血液回流的阻滞作用，术中静脉瘀滞客观存在，可增加术后静脉血栓的风险，在围手术期仍应积极采取预防措施。

关键词: 下肢深静脉, 血流动力学, 腹腔镜, 结直肠癌, 手术体位, CO2气腹

Abstract:

Effect of laparoscopic surgery CO2 pneumoperitoneum for colorectal cancer on femoral venous hemodynamics WANG Yu*，WANG Yan-ting，JIANG Yan-yan，et al.*Department of General Surgery，Fuzhou General Hospital of Nanjing Military Command，Fuzhou 350025，China Corresponding author:ZOU Zhong-dong,E-mail: fzptwk@21cn.com Abstract Objective To study the effect of the special surgical position and CO2 pneumoperitoneum on femoral venous hemodynamics during laparoscopic surgery for colorectal cancer.Methods Color Doppler ultrasound was adopted to evaluate the diameter、blood velocity and volum of the blood flow in the lower extremity with 30 patients undergoing laparoscopic surgery for colorectal cancer in Fuzhou General Hospital of Nanjing Military Command between August 2007 to June 2008,with different pressure of pneumoperitoneum（6mmHg、8mmHg、10mmHg、12mmHg）and that during the laparoscopic surgery for colorectal cancer with 12mmHgCO2 pneumoperitoneum and head-down tilt position. Results Compared with the stage before the pneumoperitoneum, no change was obserbed with the hemodynamics indexes after the establishment of 6mmHgCO2 pneumoperitoneum；when the pressure of pneumoperitoneum increases to 8mmHg, the femoral vein diameter increases、 the velocity and the amount of blood flow decrease by degrees (P<0.05) with the accrescence of pneumoperitoneum pressure. During the operation, the femoral vein diameter decreased，the velocity and the volum of blood flow increased with the head-down tilt position,but still less than the level before pneumoperitoneum, compared with the stage of prostration after pneumoperitoneum,;At the end of operation without the exhaust of CO2 gas,the femoral vein diameter returned to the level of the prostration after pneumoperitoneum, while the velocity and the volum of blood flow was still higher than that, but significantly lower than that of feet-down tilt position with pneumoperitoneum; At the end of operation with prostration and the exhaust of CO2 gas , the femoral vein diameter decreased,but still thicker than prostration without pneumoperitoneum,and the velocity and the volum of blood flow returned to the level before pneumoperitoneum. Conclusion The CO2 pneumoperitoneum can interfere the recirculation of blood，positive correlated to the pressure,witch will increase the risk of venous thrombosis ,so we should take the lower-grade of pneumoperitoneum pressure as far as possible . Besides, the head-down tilt position is conducive for the blood to recirculate ,which can improve but not fully offset the poor blood returning conducted by CO2 pneumoperitoneum .The vein stasis exists objectively in the perioperation of laparoscopic colorectal cancer operation, which will increase the risk of venous thrombosis ,and taking the active preventive measures is requisite.

Key words: laparoscope;colorectal cancer, position;CO2 pneumoperitoneum;deep veins of lower limb;hemodynamics