Comparison of pneumoperitoneum and abdominal wall lifting as to hemodynamics and surgical stress response during laparoscopic cholecystectomy

被引:65
作者
Ninomiya, K [1 ]
Kitano, S [1 ]
Yoshida, T [1 ]
Bandoh, T [1 ]
Baatar, D [1 ]
Matsumoto, T [1 ]
机构
[1] Oita Med Univ, Dept Surg 1, Oita 87955, Japan
来源
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES | 1998年 / 12卷 / 02期
关键词
laparoscopic cholecystectomy; pneumoperitoneum; abdominal wall lifting; hemodynamics; surgical stress response;
D O I
10.1007/s004649900611
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Impairments in hemodynamics during pneumoperitoneum (PP) have been noted. This study compared changes in hemodynamics and surgical stress response with PP and abdominal wall lifting (AWL) during laparoscopic cholecystectomy. Methods: Twenty patients with symptomatic cholecystolithiasis were assigned to PP (n = 10) or AWL (n = 10). Cardiac output (GO), stroke volume (SV), and ejection fraction (%EF) were measured by transesophageal echocardiography. Clearances of para-aminohippurate (C-PAH) and sodium thiosulfate (C-STS) were determined as measures of renal function. Levels of interleukin-6, C-reactive protein, white cell count, and neutrophil elastase were evaluated as indicators of surgical stress. Results: In the PP group, CO, SV, and %EF were depressed significantly during pneumoperitoneum. Immediately after and 15 min after insufflation, the C-PAH and C-STS were decreased by 78.0% and 73.8%, respectively. None of the hemodynamic parameters changed significantly in the AWL group. Surgical stress response was not different significantly between the two groups. Conclusions: In contrast to pneumoperitoneum, AWL did not alter cardiac function or renal hemodynamics. AWL may be useful in patients with cardiovascular or renal disorders.
引用
收藏
页码:124 / 128
页数:5
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