[原著］腹腔鏡下胆嚢摘出術における気腹圧の影響

概要

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The influence due to peumoperitoneum on respilatory and circulatory kinetic during laparoscopic cholecystectomy (LC) was studied. The subjects were 36 cases undergoing LC from February to August 1992. In this study, under anesthesia with neuroleptic analgesia, a muscle relaxant was administered at a sufficient dose; quantitative ventilation was performed at a laghing gas-oxygen ratio of 2:1;and pertial pressure of carbon dioxide (PaCo_2) and arterial keton body ratio (AKBR) during pneumoperitoneum were measured. Of the 36 cases, it was possible to perform LC in 32 cases. In two cases from the early period of the study, one case of suspected biliary calculus dropping, and the other case of cholecystoduodenal fistula. a laparotomy rather than LC was done. Average operation time was 2 hours and 27 minutes. Influence with the pnuemoperitoneum included the temporarily lowered AKBR just after the pneumoperitoneum under anesthesia. However, when AKBR could be kept at a pressure of 10 mmHg or lower, AKBR remained in the safety range. PaCO_2h stayed around 30 mmHg until 180 minutes, when the pressure due to pneumoperitoneum was maintained low, but it was maintained at over 14 mmHg, at 120 minutes later PaC0_2 exceeded 40 mmHg. LC, if maneuvered at a low peumoperitoneum pressre, is a safe operative procedure with a slight negative general influence.
琉球医学会,Ryukyu Medical Associationの論文