Improved Placement Technique And Its Effect In Endoscopic Surgery Of Malignant Tumor

Objective This study modified the position placement of endoscopic surgery for gynecological malignant tumors.We observed the influence of the improved placement technology on the patients' preoperative position comfort,intraoperative intraocular pressure,mean arterial pressure,airway pressure,subcutaneous emphysema in the chest and neck,pain and numbness in the lower limbs,and shoulder pain.To explore the feasibility of the technology,and provide data support and evidence-based basis for the future application of the technology.Methods We chose total 100 patients with gynecological malignant tumors who were treated by endoscopic surgery in our hospital between October 2019 and February 2020.Using random number table method as the grouping basis,we divided the research objects that met the inclusion criteria into the study group and the control group,50 cases in each group.In the control group,the conventional head low hip high lithotomy position was used,and in the observation group,the improved head low hip high lithotomy position placement technology was used.We compared the position comfort of the two groups before anesthesia.And we compared the intraocular pressure,mean arterial pressure and airway pressure after anesthesia induction(T1),after anesthesia completion and the patients in horizontal lithotomy position(T2),5 minutes after pneumoperitoneum and head low hip high(T3),30 minutes after pneumoperitoneum and head low hip high(T4),and every 30 minutes after that(T5-T11),5 minutes(T12)after pneumoperitoneum relieved,and before awake(T13);We also compared the postoperative chest and neck subcutaneous emphysema,lower extremity pain and numbness,shoulder pain between the two groups.The intraocular pressure of each time node above is measured with a hand-held contact intraocular pressure meter,and then the average value is taken as the intraocular pressure value of the time point;the average arterial pressure and airway pressure are directly recorded on the electrocardiograph monitor and anesthesia machine.Before general anesthesia,the patient fills in the Operation Position Comfort Scale after placing the horizontal lithotomy position,and investigates the patient's operation position comfort.At the end of the operation,the chest and neck were pressed by stethoscope immediately after recuperation,and subcutaneous emphysema was indicated when the voice similar to twisting hair was heard.The patients in the two groups were followed up 24 hours,48 hours and 72 hours after operation to understand the pain and numbness of lower limbs and shoulders.IBM SPSS statistical 21 software was used to analyze the collected data.P<0.05 indicates that the difference was statistically significant.The quantitative general data of the two groups which described by frequency and percentage,mean and standard deviation,median and quartile spacing were analyzed by t-test.For data is not in Gauss Distribution,Mann Whitney U test was used to compare.The qualitative data were compared by ?2 test.The incidence of subcutaneous emphysema,shoulder pain and numbness of lower limbs in the two groups at different time points after operation were compared by ?2 test as well.The mean arterial pressure,mean intraocular pressure and mean airway pressure of the two groups at the same time point were compared by two-independent-sample t-test,and the mean arterial pressure,intraocular pressure and airway pressure of multiple time points were measured by repeated measurement analysis of variance.The data of postoperative pain and numbness of lower limbs,shoulder pain and operation position comfort did not obey the Gauss Distribution,which was compared by Mann Whitney U test.Results There was no statistical difference between the two groups in general information(P>0.05);the intraocular pressure from T3 to T13 in the observation group was lower than that in the control group(P<0.05).The mean arterial pressure at T3 and T4 in the observation group was lower than that in the control group(P<0.05).The airway pressure from T4 to T11 in the observation group was lower than that in the control group,and the intraoperative changes tended to be lower than that in the control group(P<0.05).The incidence of subcutaneous emphysema in the two groups was significantly different(?2=14.446,P<0.001).The comfort score of the observation group(72.42 ± 3.33)was higher than that of the control group(54.58 ± 5.42).The difference was statistically significant(Z=-8.628,P<0.001).The incidence of numbness and pain of lower limbs in the observation group was lower than that in the control group(x2=10.176,P=0.001<0.05),and the VAS score of pain was lower than that in the control group(Z=-2.867,P=0.04<0.05).The difference was statistically significant.There was also significant difference in the incidence of numbness and pain of lower limbs between the two groups 48 hours after operation(?2=4.640,P=0.031<0.05),but there was no significant difference in VAS score of pain(Z=-1.409,P=0.159>0.05).The incidence of shoulder pain in the observation group 24 hours and 48 hours after operation was lower than that in the control group,the difference was statistically significant(?2=12.148,P<0.001;?2=4.640,P=0.031<0.05).The 24-hour postoperative VAS score of pain was lower than that of the control group(Z=-3.378,P=0.01<0.05).The difference was significant.Conclusion In laparoscopic surgery of gynecological malignant tumor,the change of intraocular pressure changes with the establishment of head low hip high amputation position and CO2 pneumoperitoneum.The improved placement technology makes the trend of intraocular pressure change more stable,which effectively alleviate the increase of intraocular pressure value,and it is more conducive to maintaining the intraocular pressure safety of patients.In the improved position placement technology,a new type of lithotomic leg stand is used,which reduces the incidence of pain and numbness in the lower limbs,reduces the degree of pain in the surgical patients to a certain extent,reduces the incidence of subcutaneous emphysema and shoulder pain,and improves the comfort of the operation position.