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標題Title: Randomized trial of low-pressure carbon dioxide-elicited pneumoperitoneum versus abdominal wall lifting for laparoscopic cholecystectomy
作者Authors: 溫義輝,Chen Y..等
上傳單位Department: 生物科技系
上傳時間Date: 2009-11-20
上傳者Author: 溫義輝
審核單位Department: 生物科技系
審核老師Teacher: 溫義輝
檔案類型Categories: 論文Thesis
關鍵詞Keyword: abdominal wall lifting, laparoscopic cholecystectomy, low-pressure pneumoperitoneum
摘要Abstract: Background: Two alternative surgical techniques for elective laparoscopic cholecystectomy (LC), low-pressure insufflation
of the peritoneal cavity and abdominal wall lifting (AWL), have been developed over time to minimize the disadvantages
associated with CO2-elicited pneumoperitoneum. To the best of our knowledge, the 2 methods have seldom been
compared as regards their relative advantages and disadvantages.
Methods: Eighty patients scheduled for elective LC were randomized into either a low-pressure (8 mmHg) CO2 insufflation
method (LPLC) group, or a gasless technique using a subcutaneous abdominal wall lifting device (GLC group). The
duration of the surgical procedure, the surgical results including level of postoperative pain, and perioperative cardiopulmonary
function changes experienced by the members of both groups were compared.
Results: Laparoscopic surgery was completed for all but 1 patient from each group due to an inadequate surgical-site
exposure. There was no mortality for study participants, and no major complications were noted for members of either group.
The LPLC group evidenced a shorter surgical duration as compared to the GLC group (77 ± 28 minutes vs. 98 ± 27 minutes,
respectively; p < 0.01) and a lower incidence of postoperative shoulder pain (2/38 vs. 8/39, respectively; p < 0.05),
although significant differences in intraoperative pulmonary function were noted (an increased PaCO2, PetCO2 and peakairway
pressure and decreased arterial blood pH; p < 0.01) for the LPLC group compared to the GLC group.
Conclusion: Both alternative methods for this type of surgery appeared feasible and safe for LC. Low-pressure CO2
pneumoperitoneum had a shorter surgical duration and less postoperative shoulder pain compared to the GLC technique,
but did not feature any other advantage over the AWL technique with regard to impact on cardiopulmonary function.

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