Randomized Comparative Study Of Gasless Laparoscopy Verus Low -pressure And High -pressure Carbon Dioxide Pneumoperitoneum For Laparoscopic Cholecystectomy

[OBJECTIVE]To study the effects of gasless laparoscopy,low-pressure and high-pressure carbon dioxide(CO₂) pneumoperitoneum on cardiopulmonary function during laparoscopic cholecystectomy(LC),To compare the difference of surgical result.[METHODS]A total of sixty patients with chronic cholecystitis,cholelithiasis or gallbladder polpy, underwent LC were were randomized into three groups: Group A (n=20) conducted by gasless laparoscopy, Group B (n=20) conducted by low-pressure CO₂-pneumoperitoneum and Group C (n=20) conducted by high-pressure CO₂-pneumoperitoneum. abdominal wall lifting (AWL) was employed in Group A to make a sufficient working space; Pneumoperitoneal pressure was controlled at 10 mmHg in Group B, and 15 mmHg in Group C. All case apply one standardization anesthesia test design. PET-CO₂ (pressure of end-tidal CO₂),PAP (peak-airway pressure),MAP(mean arterial pressure),HR (heart rate) were monitored before AWL or CO₂ insufflation(T₀),10 min after AWL or CO₂ insufflation (T₁),30 min after AWL or CO₂ insufflation(T₂) and 5min after remove AWL or CO₂-pneumoperitoneum(T₃) . Evaluate the surgical duration, bleed volume, postoperative complication of nausea,vomito,drowsiness,dizziness,shoulder pain ,et al;and postoperative anesthesia's extube time,postoperative take drink and food time,passage of gas by anus's time and postoperative length of stay were compared.[RESULTS]1. PET-CO2 was not marked change in Group A after AWL , there was not significantly difference at T₁,T₂,T₃ than that at T₀. PET-CO₂ after CO₂-pneumoperitoneum in Group B and Group C at T₁,T₂ were significantly higher than that at T₀ (P＜0.01); PET-CO₂ decreased after CO₂-pneumoperitoneum removed, there were not significantly difference on PET-CO₂ at T₃ than that at T₀. There was significantly difference among PET-CO₂ in groups at T₁,T₂ (P＜0.01) , not significantly difference at T₃.2. PAP was not marked change in Group A after AWL , there was not significantly difference at T₁,T₂,T₃ than that at T₀. PAP after CO₂-pneumoperitoneum in Group B and Group C at T₁,T₂ were significantly higher than that at T₀ (P＜0.01); PAP decreased after CO₂-pneumoperitoneum removed, there were not significantly difference on PAP at T₃ than that at T₀. There was significantly difference among PAP in groups at T₁,T₂(P＜0.01) , not significantly difference at T₃.3. MAP was not marked change in Group A after AWL , there was not significantly difference at T₁,T₂,T₃ than that at T0. MAP after CO₂-pneumoperitoneum in Group B and Group C at T₁ were significantly higher than that at T₀ (P＜0.05); MAP in Group B and Group C at T₂,T₃ descended, there were not significantly difference than that at T₀. There was significantly difference among MAP in groups at T₁ (P＜0.05) , not significantly difference at T₂,T₃.4. HR was not marked change in Group A after AWL , there was not significantly difference at T₁,T₂,T₃ than that at T₀ (P＞0.05) . HR after CO₂-pneumoperitoneum in Group B and Group C at T₁ were significantly higher than that at T₀ (P＜0.05); HR in Group B and Group C at T₂,T₃ descended, there were not significantly difference than that at T₀ (P＞0.05) . There was significantly difference among HR in groups at T₁(P＜0.05) , not significantly difference at T₂,T₃.5. All cases were operated successfully, no one converted to open cholecystectomy.The surgical duration in Group A was significantly longer than that in Group B and Group C, that in Group B was significantly longer than that in Group C. The bleed volume in Group A was more than that in Group B and Group C, but there was not significantly difference in each group.6. Postoperative anesthesia's extube time and postoperative take drink and food time in Group A were significantly early than that in Group B and Group C (P＜0.01), passage of gas by anus's time in Group A were significantly early than that in Group B and Group C(P＜0.05), and there was not significantly difference on postoperative length of stay in each group.7. there were was no mortality and no serious complications were noted and the patients recovered smoothly.The incidence of shouder pain in Group C was significantly higher than that in Group A and Group B (P＜0.01) ,and there was not significantly difference on incidence of nausea,vomito,drowsiness,dizziness in each group.[CONCLUSION]1. CO₂-pneumoperitoneum caused a significant impairment in cardiopulmonary functions. There was significance in the select of suitable pressure of CO₂-pneumoperitoneum for the safety of systema respiratorium and systema circulatorium. Low-pressure CO₂-pneumoperitoneum may reduce the impact of CO₂-pneumoperitoneum during laparoscopic procedures, and gasless laparoscopy can avoid the harmful effects of CO₂-pneumoperitoneum,increasing the operative safety .2.Gasless laparoscopy LC and low-pressure CO₂-pneumoperitoneum can build sufficient operative space,though the surgical duration are longer than high-pressure CO₂-pneumoperitoneum ,there were not obvious impact in the performance of LC.3.Gasless laparoscopy can make alert recover fastly and shorten the postoperative anesthesia's extube time.It also have rapid recover on postoperative take drink and food time,passage of gas by anus's time.4.There was a higher incidence of postoperative shoulder pain after LC in high-pressure CO₂-pneumoperitoneum than that in low-pressure CO₂-pneumoperitoneum gasless laparoscopy . Gasless laparoscopy wasn't increase operative complication ,and its incidence of total postoperative complication have not significantly difference than that after CO₂-pneumoperitoneum LC.5. Gasless laparoscopy multiply the indication to laparoscopic surgery, in high-risk patients with cardiorespiratory diseases or old patients gasless laparoscopy may be preferred for reliability and absence of cardiopulmonary alterations.