目的:探讨腹腔镜经腹腹膜前腹股沟斜疝修补术(TAPP)中腹膜前间隙CO2与血清肿形成的关系。方法:选取2023年1月至2023年6月于青岛大学附属医院确诊腹股沟斜疝并完成TAPP治疗的101例患者,随机分为试验组(减少腹膜前CO2残余)和对照组。主要...目的:探讨腹腔镜经腹腹膜前腹股沟斜疝修补术(TAPP)中腹膜前间隙CO2与血清肿形成的关系。方法:选取2023年1月至2023年6月于青岛大学附属医院确诊腹股沟斜疝并完成TAPP治疗的101例患者,随机分为试验组(减少腹膜前CO2残余)和对照组。主要结局是比较术后14天、1个月彩色多普勒超声下的血清肿发生情况。次要结局包括术后疼痛程度,复发,感染等。结果:两组患者的年龄、疝环直径、体质量指数(BMI)、病程等基线人口学特征均无显著性差异(P均 > 0.05)。术后14天试验组血清肿体积、发生率,疼痛程度均明显低于对照组,差异有统计学意义(P均 0.05)。其余次要结局均无显著性差异(P均 > 0.05),随访期间两组未出现复发、感染等其他术后并发症。结论:腹腔镜经腹腹膜前腹股沟疝修补术(TAPP)术中减少腹膜前间隙残留CO2是一种安全有效、操作简便的方法,能显著降低血清肿发生率和体积,减轻术后疼痛。Objective: To explore the relationship between CO2 in preperitoneal space and seroma formation in laparoscopic preperitoneal inguinal hernia repair (TAPP). Methods: 101 patients with indirect inguinal hernia diagnosed in the Affiliated Hospital of Qingdao University from January 2023 to June 2023 and completed TAPP treatment were randomly divided into an experimental group (reducing the residual CO2 before peritoneum) and a control group. The main outcome was to compare the incidence of seroma under color Doppler ultrasound 14 days and 1 month after operation. Secondary outcomes included postoperative pain, recurrence and infection. Results: There was no significant difference in baseline demographic characteristics such as age, diameter of hernia ring, body mass index (BMI) and course of disease between the two groups (P > 0.05). Fourteen days after operation, the volume of serum swelling, the incidence rate and the degree of pain in the experimental group were significantly lower than those in the control group, and the difference was statistically significant (P 0.05). There was no significant difference in other secondary outcomes (P > 0.05), and there were no other postoperative complications such as recurrence and infection in the two groups during the follow-up period. Conclusion: Laparoscopic preperitoneal inguinal hernia repair (TAPP) is a safe, effective and simple method to reduce residual CO2 in preperitoneal space, which can significantly reduce the incidence and volume of seroma and relieve postoperative pain.展开更多
腹股沟疝是通过先天缺损或者老年人腹股沟区腹壁力量减弱造成腹腔脏器通过缺损移位,造成腹股沟区坠胀感、甚至造成肠梗阻、肠坏死等症状,严重影响患者生命安全。据相关统计学资料统计,我国每年有超过100万例的腹股沟疝修补术需要开展,...腹股沟疝是通过先天缺损或者老年人腹股沟区腹壁力量减弱造成腹腔脏器通过缺损移位,造成腹股沟区坠胀感、甚至造成肠梗阻、肠坏死等症状,严重影响患者生命安全。据相关统计学资料统计,我国每年有超过100万例的腹股沟疝修补术需要开展,数量甚至大于欧美和美国相同疾病的总和。目前采用的主要微创的手术方式为TEP、TAPP,但TEP、TAPP两种手术方式创建的操作空间不同,多项研究发现两者对二氧化碳气腹的反应存在差异,本综述就二氧化碳对机体的循环、呼吸、消化系统等方面的影响,以及通过麻醉药物的选择、手术方式的选择、气腹压的选择、术后镇痛、呼吸道管理等围手术的管理来降低二氧化碳气腹的影响。Inguinal hernia is caused by congenital defect or the weakening of abdominal wall strength in the inguinal region of the elderly, which causes the displacement of abdominal organs through the defect, resulting in a sense of bulge in the inguinal region, even causing intestinal obstruction, intestinal necrosis and other symptoms, which seriously affects the life safety of patients. According to relevant statistical data, there are more than 1 million cases of inguinal hernia repair in China every year, and the number is even greater than the sum of the same diseases in Europe, America and the United States. The main minimally invasive surgical methods currently used are TEP and TAPP, but the operating space created by the two surgical methods of TEP and TAPP is different. A number of studies have found that there are differences in the response to carbon dioxide pneumoperitoneum. This review focuses on the effects of carbon dioxide on the body’s circulation, respiration, digestive system and other aspects, as well as the choice of anesthetic drugs, the choice of surgical methods, the choice of pneumoperitoneum pressure, postoperative analgesia, respiratory management and other perioperative management to reduce the impact of carbon dioxide pneumoperitoneum.展开更多
文摘目的:探讨腹腔镜经腹腹膜前腹股沟斜疝修补术(TAPP)中腹膜前间隙CO2与血清肿形成的关系。方法:选取2023年1月至2023年6月于青岛大学附属医院确诊腹股沟斜疝并完成TAPP治疗的101例患者,随机分为试验组(减少腹膜前CO2残余)和对照组。主要结局是比较术后14天、1个月彩色多普勒超声下的血清肿发生情况。次要结局包括术后疼痛程度,复发,感染等。结果:两组患者的年龄、疝环直径、体质量指数(BMI)、病程等基线人口学特征均无显著性差异(P均 > 0.05)。术后14天试验组血清肿体积、发生率,疼痛程度均明显低于对照组,差异有统计学意义(P均 0.05)。其余次要结局均无显著性差异(P均 > 0.05),随访期间两组未出现复发、感染等其他术后并发症。结论:腹腔镜经腹腹膜前腹股沟疝修补术(TAPP)术中减少腹膜前间隙残留CO2是一种安全有效、操作简便的方法,能显著降低血清肿发生率和体积,减轻术后疼痛。Objective: To explore the relationship between CO2 in preperitoneal space and seroma formation in laparoscopic preperitoneal inguinal hernia repair (TAPP). Methods: 101 patients with indirect inguinal hernia diagnosed in the Affiliated Hospital of Qingdao University from January 2023 to June 2023 and completed TAPP treatment were randomly divided into an experimental group (reducing the residual CO2 before peritoneum) and a control group. The main outcome was to compare the incidence of seroma under color Doppler ultrasound 14 days and 1 month after operation. Secondary outcomes included postoperative pain, recurrence and infection. Results: There was no significant difference in baseline demographic characteristics such as age, diameter of hernia ring, body mass index (BMI) and course of disease between the two groups (P > 0.05). Fourteen days after operation, the volume of serum swelling, the incidence rate and the degree of pain in the experimental group were significantly lower than those in the control group, and the difference was statistically significant (P 0.05). There was no significant difference in other secondary outcomes (P > 0.05), and there were no other postoperative complications such as recurrence and infection in the two groups during the follow-up period. Conclusion: Laparoscopic preperitoneal inguinal hernia repair (TAPP) is a safe, effective and simple method to reduce residual CO2 in preperitoneal space, which can significantly reduce the incidence and volume of seroma and relieve postoperative pain.
文摘腹股沟疝是通过先天缺损或者老年人腹股沟区腹壁力量减弱造成腹腔脏器通过缺损移位,造成腹股沟区坠胀感、甚至造成肠梗阻、肠坏死等症状,严重影响患者生命安全。据相关统计学资料统计,我国每年有超过100万例的腹股沟疝修补术需要开展,数量甚至大于欧美和美国相同疾病的总和。目前采用的主要微创的手术方式为TEP、TAPP,但TEP、TAPP两种手术方式创建的操作空间不同,多项研究发现两者对二氧化碳气腹的反应存在差异,本综述就二氧化碳对机体的循环、呼吸、消化系统等方面的影响,以及通过麻醉药物的选择、手术方式的选择、气腹压的选择、术后镇痛、呼吸道管理等围手术的管理来降低二氧化碳气腹的影响。Inguinal hernia is caused by congenital defect or the weakening of abdominal wall strength in the inguinal region of the elderly, which causes the displacement of abdominal organs through the defect, resulting in a sense of bulge in the inguinal region, even causing intestinal obstruction, intestinal necrosis and other symptoms, which seriously affects the life safety of patients. According to relevant statistical data, there are more than 1 million cases of inguinal hernia repair in China every year, and the number is even greater than the sum of the same diseases in Europe, America and the United States. The main minimally invasive surgical methods currently used are TEP and TAPP, but the operating space created by the two surgical methods of TEP and TAPP is different. A number of studies have found that there are differences in the response to carbon dioxide pneumoperitoneum. This review focuses on the effects of carbon dioxide on the body’s circulation, respiration, digestive system and other aspects, as well as the choice of anesthetic drugs, the choice of surgical methods, the choice of pneumoperitoneum pressure, postoperative analgesia, respiratory management and other perioperative management to reduce the impact of carbon dioxide pneumoperitoneum.
