Clinical Research On Low Pressure Carbon Dioxide Pneumoperitoneum Applied In Laparoscopic Cholecystectomy In High Altitude Area

Objective The research is to explore influences of low-pressure carbon dioxide pneumoperitoneum on bodies treated with laparoscopic cholecystectomy in high-altitude area,and to provide experimental and theoretical foundations for application of low pneumoperitoneum pressure in the surgery.Method A total of 120 inpatients who were diagnosed as gallstone or combined chronic cholecystitis in the General Surgery Department of the Tibet Autonomous Region People's Hospital and selected to undergo laparoscope cholecystectomy under general anesthesia were collected,and all of the cases were diagnosed with preoperative MRI or ultrasound examination.The patients were clear for cardiac,pulmonary,hepatic,renal diseases as well as diseases of hematologic system and immune system.The patients were randomly divided into the high-pressure group?the H group;n=62?with a carbon dioxide pneumoperitoneum pressure of 14 mmHg and the low-pressure group?the L group;n=58?with a carbon dioxide pneumoperitoneum pressure of 10 mmHg.Data,including age,weight,operation time and hospitalization duration,of the two groups was recorded;liver function[incl.aspartate aminotransferase?AST?,alanine transaminase?ALT?and total bilirubin?TBIL?],renal function[incl.creatinine?Cr?and blood urea nitrogen?BUN?],coagulation function[incl.D-dimer,fibrinogen?FIB?,activated partial thromboplastin time?APTT?],and humoral immunity?incl.IgG,IgA and IgM?were tested before operation and on 1^st and 3^rd days after operation;patients'heart rates?HRs?,mean arterial pressures?MAPs?and end expiratory partial pressures of carbon dioxide(P_ETCO₂)were recorded at20-minute before and after pneumoperitoneum and at 20-minute after air exhaustion.Result The followings were obtained from the experiment.1.There was no statistically significant difference of age,weight,hospitalization duration and operation time between the two groups?P>0.05?.2.The two groups suggested no statistically significant difference of HR and MAP at20-minute before and after pneumoperitoneum and at 20-minute after air exhaustion?P>0.05?;comparison of P_ETCO₂ before pneumoperitoneum and at 20-minute after air exhaustion suggested no statistically significant difference?P>0.05?,but the comparison of P_ETCO₂ at 20-minute after pneumoperitoneum indicated statistically significant difference?P<0.05?.3.The two groups were significantly different for AST and ALT on the 1^stt day after operation and for ALT on the 3^rd day after operation?P<0.05?,but suggested no statistically significant difference of TBIL and AST on the 3^rd day after operation?P>0.05?.4.For renal function test,Cr and BUN results before operation and on the 1^st and 3^rd days after operation showed no statistically significant difference?P>0.05?.5.Regarding coagulation function,comparisons of D-dimer and FIB on the 3^rd day after operation suggested statistically significant differences between the two groups?P<0.05?,while the differences before operation and on the 1^stt day after operation were both insignificant?P>0.05?;comparisons of APTT at different timings showed no statistical significance?P>0.05?.6.According to the humoral immune test results,the two groups suggested no statistically significant difference of IgA,IgG and IgM before operation and on the 1^st and 3^rd days after operation?P>0.05?.7.The two groups were significantly different for occurrences of neck and shoulder pain?P<0.05?,but suggested no statistically significant difference of postoperative nausea,vomiting and irregular heart rate?P>0.05?.Conclusion:1.In high-altitude area,application of low-pressure carbon dioxide in laparoscopic cholecystectomy provides satisfactory surgical field,and neither affects surgical operation nor prolongs operative time and hospitalization duration.2.When undergoing laparoscopic cholecystectomy in high-altitude area,application of low-pressure carbon dioxide pneumoperitoneum is associated with a lower intraoperative end expiratory partial pressure of carbon dioxide and lower occurrence of hypercapnia.The low-pressure group has a lower postoperative occurrence of neck and shoulder pain,suggesting smaller impact on body and better recovery.3.Application of low-pressure carbon dioxide pneumoperitoneum when performing laparoscopic cholecystectomy in high-altitude area has relatively less influence on liver and coagulation functions.