Effect Of Gynecological Laparoscopic Operations On Venous Blood Stream Of The Lower Extremity

Background: CO2 pneumoperitonium and patient position have an disadvantage effect on Respiratory and Circulatory system of organism,especially on the venous blood flow in the lower extremity,which may lead to increase in postoperative DVT.Objectives: To study the effect of CO2 pneumoperitoneum and especial patient position on the diameter, the velocity and the amount of the blood flow of the femoral vein in the lower extremity.Method: Color duplex ultrasound were adopted to evaluate the diameter and blood velocity of the femoral vein in the lower extremity of the twenty-two patients undergoing gynecologic laparoscopy under the same pressure of pneumoperitoneum of 12 mmHg. The respective value under the pneumoperitoneum and different position were got and the amount of the blood flow were calculated with the equation of . Comparison was made of the difference in the parameters before and after the establishment of pneumoperitoneum and of different position.Result: Eighteen patients completed the research. After anesthesia and before the establishment of pneumoperitoneum ,the mean diameter and blood velocity and the amount of the blood flow of the femoral vein in the lower extremity were 0.76cm, 28.67cm/s and 13.21cm3 respectively. Compared with that before the establishment of the pneumoperitoneum,the diameter of the femoral vein increased 26%(0.95cm, P<0.05)and blood velocity decreased to 14.72cm/s(P <0.05) and amount of blood flow induced to 10.53 cm3 (P<0.05) after the establishment of pneumoperitoneum. And the 30 degree head-down tilt position increased velocity and amount of blood flow of the femoral vein and decreased the diameter of the vessel (P<0.05). But at the time of 30 minutes of the 30 degree head-down tilt position, again the femoral vein was dilated and the velocity and amount of blood flow was decreased. But compared with that at the prone position after the establishment of the pneumoperitoneum, the velocity and the amount of the blood flow was increased (P<0.05).After the expel of CO2, the velocity and the amount of the blood flow of femoral vein were 28.94 cm/s and 13.88 cm3 respectively,and the difference was not evident compared with that before the establishment of pneumoperitoneum(P> 0.05).But the diameter of the femoral vein still increased 8% than that before the establishment of pneumoperitoneum (0.82cm, P<0.05).Conclusion:1. CO2 pneumoperitoneum may result in the venous dilation and blood flow retard in the lower extremity.2. The change of the position during laparoscopy may influence the flow back of venous blood. The 30 degree head-down tilt position after the establishment of pneumoperitoneum can ameliorate the blood flow status and result in the increase in the velocity and amount of blood flow.3.After the expel of CO2 and before patients awoken, the diameter of the femoral vein remains dilated.