Pulmonary function after laparoscopic cholecystectomy.
Pulmonary function after laparoscopic cholecystectomy.
复制标题
腹腔镜胆囊切除术后的肺功能。
作者：
P. Schauer;J. Luna;A. Ghiatas;M. Glen;J. M. Warren;K. Sirinek
背景
本研究旨在前瞻性比较腹腔镜胆囊切除术（LC）与开腹胆囊切除术（OC）对术后肺功能的影响。
方法
40例肺部危险因素均匀匹配的连续患者（每组20例）被分配到择期LC或OC组。在手术前后对两组患者进行肺功能检查、血氧饱和度检查和胸部X线检查，直至达到基线水平。比较两组麻醉剂用量和肺部并发症。采用t检验、方差分析和卡方分析。
结果
与接受OC的患者相比，接受LC的患者在所有研究领域的术后肺损伤均显著降低（30%至38%），包括用力肺活量、1秒用力呼气量、用力呼气流量、呼气中期、最大用力呼气流量、最大自主通气量、肺总容量和血氧饱和度。肺功能在LC后4 - 10天恢复到基线水平。LC术后肺部并发症包括肺不张和缺氧较少发生。LC组术后止痛药需求减少了8倍。
结论
与OC相比，腹腔镜胆囊切除术可显著降低肺功能损害和麻醉需求，从而减少术后肺部并发症。腹腔镜胆囊切除术应被认为是选择性胆囊切除术的程序。
BACKGROUND
The purpose of this study was to prospectively compare the effect of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) on postoperative pulmonary function.
METHODS
Forty consecutive patients (20 in each group) who were evenly matched in terms of pulmonary risk factors were assigned to either elective LC or OC. Pulmonary function studies, oxygen saturation, and chest radiography were performed on both groups before and after the operation until baseline levels were reached. Narcotic requirements and pulmonary complications were compared. The t test, ANOVA, and chi-squared analysis were used.
RESULTS
Compared to the patients who underwent OC, patients who underwent LC had a significant reduction in postoperative pulmonary impairment (30% to 38%) in all areas studied including forced vital capacity; forced expiratory volume in 1 second; forced expiratory flow, mid-expiratory phase; maximum forced expiratory flow; maximum voluntary ventilation; total lung capacity; and oxygen saturation. Pulmonary function returned to baseline levels 4 to 10 days sooner after LC. Pulmonary complications including atelectasis and hypoxia were less frequent after LC. An eight-fold decrease was noted in postoperative pain medication requirement in the LC group.
CONCLUSIONS
Compared to OC, laparoscopic cholecystectomy results in a significantly reduced compromise in pulmonary function and narcotic requirement leading to fewer postoperative pulmonary complications. Laparoscopic cholecystectomy should be considered the procedure of choice for elective cholecystectomy.