老年妇科腹腔镜微创手术的肺功能及相关因素分析
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摘要
目的:探讨腹腔镜在合并肺功能异常的老年人妇科手术的可行性和应用价值。方法:回顾性分析我院2010年1月至2015年10月,因妇科疾病择期实施手术治疗的97例老年患者的临床资料,按是否行腹腔镜手术治疗分为腹腔镜组和非腹腔镜组,比较两组患者的术前肺功能指标、手术时间、手术出血量、并发症率、手术后肠道功能恢复时间、腹腔引流量及住院时间。结果:两组患者术前肺功能、术后肠功能恢复时间、住院时间、并发症率差异有统计学意义(P<0.05)。手术时间、手术出血量、腹腔引流量差异无统计学意义(P>0.05)。结论:老年患者行腹腔镜治疗是安全可行的,有利于患者术后免疫功能的恢复,降低肺部并发症的发生。术前肺功能异常是肺部并发症的危险因素,应综合评估术前全身机能状况,重视围手术期各种呼吸道肺保护措施的应用,降低对呼吸功能的影响。
Objective: Tostudy the value of laparoscopic surgery technique for the aged patients withgynecologicaldiseases. Methods: The clinical data of 97 cases accepted gynecologic operationwerea Ilalyzed retrospectively,and all the patients aged over 60. These patients were divided into the two groups based on with or without laparoscopyoperation. Seven relative factors including pulmonary function,the surgery duration,bleeding,complications,postoperativeaerofluxus time,abdominal drainage and the time of hospitalization. Results:The patients treated by non laparoscopicoperation had pulmonary function slower,longer postoperativeaerofluxustime,the time of hospitalization and complications which had significant stastical difference with laparoscopic operation( P < 0. 05). But there was no significant different in the surgery duration,bleedingand the abdominal drainage between the two groups( P > 0. 05). Conclusion: Laparoscopic surgery technique is safe and feasible for the aged patients withgynecological diseases and beneficial to the recovery of immune function while reduce the incidence of pulmonary complications. The pulmonary dysfunction may be risk factors of pulmonary complications. The key steps are wholely appraising systematic condition and emphasis on the application of various respiratory protective measures so as to reduce the effect on respiratory function.
Objective: Tostudy the value of laparoscopic surgery technique for the aged patients withgynecologicaldiseases. Methods: The clinical data of 97 cases accepted gynecologic operationwerea Ilalyzed retrospectively,and all the patients aged over 60. These patients were divided into the two groups based on with or without laparoscopyoperation. Seven relative factors including pulmonary function,the surgery duration,bleeding,complications,postoperativeaerofluxus time,abdominal drainage and the time of hospitalization. Results:The patients treated by non laparoscopicoperation had pulmonary function slower,longer postoperativeaerofluxustime,the time of hospitalization and complications which had significant stastical difference with laparoscopic operation( P < 0. 05). But there was no significant different in the surgery duration,bleedingand the abdominal drainage between the two groups( P > 0. 05). Conclusion: Laparoscopic surgery technique is safe and feasible for the aged patients withgynecological diseases and beneficial to the recovery of immune function while reduce the incidence of pulmonary complications. The pulmonary dysfunction may be risk factors of pulmonary complications. The key steps are wholely appraising systematic condition and emphasis on the application of various respiratory protective measures so as to reduce the effect on respiratory function.
引文
[1]王泽华,董卫红.我国妇科腹腔镜手术发展历程及展望.中国医师杂志,2015,17:481-483.
[2]Yang YS,Kim SH,Jin CH,et al.Solo surgeon single-port laparoscopic surgery with a homemade laparoscope-anchored instrument system in benign gynecologic diseases.J Minim Invasive Gynecol,2014,21:695-701.
[3]Dunn M,Cnor D.Preventing preoperative complication in an older adult:Leam how his advancing age affects his risks so you can take steps to head off trouble.Holist Nurs Pract,2005,19:54-59.
[4]Harjola VP,Mebazaa A,CˇelutkienèJ,et al.Contemporary management of acute right ventricular failure:a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology.Eur J Heart Fail,2016,18:226-241.
[5]Park JY,Kim DY,Suh DS,et al.Laparoendoscopic single-site versus conventional laparoscopic surgery for ovarian mature cystic teratoma.Obstet Gynecol Sci,2015,58:294-301.
[6]袁玮,王浩彦,徐秋芬,等.慢性阻塞性肺疾病患者运动能力与通气效率的相关性分析.心肺血管病杂志,2013,32:57-60.
[7]高素艳,王影,高健,等.腹腔镜技术在老年妇科疾病的应用价值.腹腔镜外科杂志,2011,16:350-351.
[8]卢增停,王立勋,李瑞钰,等.腹腔镜手术CO2气腹对全身麻醉患者通气功能的影响及呼吸调节的疗效观察.河北医学,2012,18:1033-1036.
[9]黄惠雪,王浩彦,李京明,等.稳定期慢性阻塞性肺疾病细菌定植与炎症细胞的关系.心肺血管病杂志,2007,26:103-104,107.
[10]Romagnoli S,Ricci Z,Ronco C.Novel Extracorporeal Therapies for Combined Renal-Pulmonary Dysfunction.Semin Nephrol,2016,36:71-77.
[11]刘玉婷,刘玉革,刘亚华,等.妇科腹腔镜手术对肥胖患者呼吸力学和肺换气功能的影响.中国内镜杂志,2015,21:802-805.
[12]Huang CY,Wu KY,Su H,et al.Accessibility and surgical outcomes of transumbilical single-port laparoscopy using straight instruments for hysterectomy in difficult conditions.Taiwan J Obstet Gynecol,2014,53:471-475.
[13]蒋小兰.妇科腹腔镜手术的研究进展.中国医药指南,2013,11:467-469.
[14]Park JY,Kim DY,Kim SH,et al.Laparoendoscopic Single-site Compared With Conventional Laparoscopic Ovarian Cystectomy for Ovarian Endometrioma.Minim Invasive Gynecol,2015,56:813-819.
[15]Ghezzi F,Cromi A,Serati M,et al.Radiation-induced bowel complications:laparoscopic versus open staging of gynecologic malignancy.Ann Surg Oncol,2011,18:782-791.
[16]木若文,木若南,华莹.妇科腹腔镜手术并发症的临床分析及预防措施.中华医院感染学杂志,2013,23:6047-6048.
[17]程虹,黄守国,林卫琼.盆腹腔手术史对妇科微创手术治疗效果的影响.中国内镜杂志,2015,21:943-947.
[18]林莉芝,邸晓君,田晓莉.妇科腹腔镜术后并发症的预防及护理.白求恩军医学院学报,2011,9:73-74.
[19]柳春韬,李冰,王学慧,等.妇科腹腔镜手术23例并发症临床分析.中国综合临床,2015,31:948-950.
[20]Jun Kumakiri,Iwaho Kikuchi,Mari Kitade,et al.Incidence of Complications during Gynecologic Laparoscopic Surgery in Patients after Previous Laparotomy.J Minimal Inv Gynecol,2010,17:480-486.
[21]Minas V,Gul N,Aust T,et al.Urinary tract injuries in laparoscopic gynaecological surgery;prevention,recognition and management.Obstet Gynaecol,2014,16:19-28.
[22]Kratz KG,Spytek SH,Caceres A,et al.A randomized,singleblinded pilot study evaluating use of a laparoscope or a cystoscope for cystoscopy during gynecologic surgery.J Minim Invasive Gynecol,2012,19:606-614.
[23]Kumakiri J,Kikuchi I,Ozaki R,et al.Feasibility of laparoscopically assisted extracorporeal cystectomy via single suprapubic incision using an adjustable-view laparoscope to treat large benign ovarian cysts:comparison with conventional procedure.Eur J Obstet Gynecol Reprod Biol,2013,168:64-67.
[2]Yang YS,Kim SH,Jin CH,et al.Solo surgeon single-port laparoscopic surgery with a homemade laparoscope-anchored instrument system in benign gynecologic diseases.J Minim Invasive Gynecol,2014,21:695-701.
[3]Dunn M,Cnor D.Preventing preoperative complication in an older adult:Leam how his advancing age affects his risks so you can take steps to head off trouble.Holist Nurs Pract,2005,19:54-59.
[4]Harjola VP,Mebazaa A,CˇelutkienèJ,et al.Contemporary management of acute right ventricular failure:a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology.Eur J Heart Fail,2016,18:226-241.
[5]Park JY,Kim DY,Suh DS,et al.Laparoendoscopic single-site versus conventional laparoscopic surgery for ovarian mature cystic teratoma.Obstet Gynecol Sci,2015,58:294-301.
[6]袁玮,王浩彦,徐秋芬,等.慢性阻塞性肺疾病患者运动能力与通气效率的相关性分析.心肺血管病杂志,2013,32:57-60.
[7]高素艳,王影,高健,等.腹腔镜技术在老年妇科疾病的应用价值.腹腔镜外科杂志,2011,16:350-351.
[8]卢增停,王立勋,李瑞钰,等.腹腔镜手术CO2气腹对全身麻醉患者通气功能的影响及呼吸调节的疗效观察.河北医学,2012,18:1033-1036.
[9]黄惠雪,王浩彦,李京明,等.稳定期慢性阻塞性肺疾病细菌定植与炎症细胞的关系.心肺血管病杂志,2007,26:103-104,107.
[10]Romagnoli S,Ricci Z,Ronco C.Novel Extracorporeal Therapies for Combined Renal-Pulmonary Dysfunction.Semin Nephrol,2016,36:71-77.
[11]刘玉婷,刘玉革,刘亚华,等.妇科腹腔镜手术对肥胖患者呼吸力学和肺换气功能的影响.中国内镜杂志,2015,21:802-805.
[12]Huang CY,Wu KY,Su H,et al.Accessibility and surgical outcomes of transumbilical single-port laparoscopy using straight instruments for hysterectomy in difficult conditions.Taiwan J Obstet Gynecol,2014,53:471-475.
[13]蒋小兰.妇科腹腔镜手术的研究进展.中国医药指南,2013,11:467-469.
[14]Park JY,Kim DY,Kim SH,et al.Laparoendoscopic Single-site Compared With Conventional Laparoscopic Ovarian Cystectomy for Ovarian Endometrioma.Minim Invasive Gynecol,2015,56:813-819.
[15]Ghezzi F,Cromi A,Serati M,et al.Radiation-induced bowel complications:laparoscopic versus open staging of gynecologic malignancy.Ann Surg Oncol,2011,18:782-791.
[16]木若文,木若南,华莹.妇科腹腔镜手术并发症的临床分析及预防措施.中华医院感染学杂志,2013,23:6047-6048.
[17]程虹,黄守国,林卫琼.盆腹腔手术史对妇科微创手术治疗效果的影响.中国内镜杂志,2015,21:943-947.
[18]林莉芝,邸晓君,田晓莉.妇科腹腔镜术后并发症的预防及护理.白求恩军医学院学报,2011,9:73-74.
[19]柳春韬,李冰,王学慧,等.妇科腹腔镜手术23例并发症临床分析.中国综合临床,2015,31:948-950.
[20]Jun Kumakiri,Iwaho Kikuchi,Mari Kitade,et al.Incidence of Complications during Gynecologic Laparoscopic Surgery in Patients after Previous Laparotomy.J Minimal Inv Gynecol,2010,17:480-486.
[21]Minas V,Gul N,Aust T,et al.Urinary tract injuries in laparoscopic gynaecological surgery;prevention,recognition and management.Obstet Gynaecol,2014,16:19-28.
[22]Kratz KG,Spytek SH,Caceres A,et al.A randomized,singleblinded pilot study evaluating use of a laparoscope or a cystoscope for cystoscopy during gynecologic surgery.J Minim Invasive Gynecol,2012,19:606-614.
[23]Kumakiri J,Kikuchi I,Ozaki R,et al.Feasibility of laparoscopically assisted extracorporeal cystectomy via single suprapubic incision using an adjustable-view laparoscope to treat large benign ovarian cysts:comparison with conventional procedure.Eur J Obstet Gynecol Reprod Biol,2013,168:64-67.