| In March 1987, Dr. Mouret successfully carried out the first laparoscopic cholecystectomy (LC) by means of electronic laparoscopy, which made a great stir in the surgical field all over the world. Since February 1991, this technique has been widely spreaded all over our country. As a new method with minimal surgical stress and without contravening conventional surgery principle, LC has combined new technique with conventional surgery and has been unparalleled generally approved by the field of surgery in surgical history. But pneumoperitoneum is needed to separate abdominal wall from abdominal organs to make LC performed easily and clearly. Nowadays, Carbon dioxide (CO2) is generally used in pneumoperitoneum for laparoscopy undergoing charging operation, while it might cause some specific complications after laparoscopy. Shoulder pain, which is frequently reported by 35%-80% of patients, is so severe sometimes that it preponderate over incision pain and becomes the main discomfort. It can be alleviated by changing the type of pneumoperitoneum, placing routine drainage, injecting local anesthetic, eliciting celiac gas, injecting analgesic via muscle or vein perioperative, combining anaethesia and so on, but all these methods have their limitations. The pathogenesis is still unknown and there are few literatures on it. Further studies should be introduced to clarify the cause of shoulder pain and to find the best way of preventing and managing the complication. Laparoscopic operation is characteristic not only mild incision, but also less influence on body immunity, stress, metabolizability, respiration and circulation function. The conception of modern surgery is to maintain homoeostasis as possible as we can, while the stress to surgery and change of immunity functions can reflect homoeostasis. This study is to investigate if the different CO2 pressure used in LC has any effects on the duration of pneumoperitoneum, the occurrence of postoperative shoulder pain, adrenocorticotropic hormone (ACTH), cortisol (COR), prostaglandin E2 (PGE2), nitric oxide (NO), nitric oxide synthase (NOS), inducible nitric oxide synthase (iNOS), constructive nitric oxide synthase (cNOS) and peritoneal morphology, and to explore the cause of shoulder pain in search of best bet on preventing and managing of shoulder pain, to explicit if the CO2 pressure has any effects on the neuroendocrine response as well as immunity function.1. The effects of different CO2 pneumoperitoneum pressure on duration of pneumoperitoneum and shoulder pain following LCObjective: To define the duration of pneumoperitoneum and to identify factors which affect resolution time and shoulder pain. Methods: Sixty-nine patients underwent LC were randomized into three groups (with 23 patients in each group): patients in group A underwent LC with 10 mmHg CO2, those in group B with 12 mmHg CO2, and those in group C with 14 mmHg CO2. Serial chest X ray were taken until all residual gas was resolved. The X ray's results were analysed by a consultant radiologist. The volume of residual gas bubble under each hemi-diaphragm 24h afteer operation was calculated by making of length of arc and height of the gas. The intensity of shoulder pain was recorded on a visual analogue score (VAS) 1, 3, 6, 12, 24, 48, 72, 96, 120h after operation.Results: Pneumooperitoneum disappeared within 24 h in 37patients, 3 to 5 days in 4 patients, 5 to 6 days in 1 patient. Mean resolution time for all patients was 1.77±1.07 days.There was no apparent difference in resolution time between male and female;. Duration of the pneumoperitoneum was correlated with the volume under right hemi-diaphragm(r=0.616,p<0.001) and pneumoperitoneum time (r=-0.228,p=0.014), but was not correlated with gender, age, weight, duration of operation, volume of consumed CO2 .The intraoperative CO2 consumption was significantly higher in group C (q=11.72, p=0.046) than that in group A. There was no apparent difference in resolution time and the volume under right hemi-diaphragm 24h afte operation b...
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