Traumatic Controlstudy In The Perioperative Period Of Laparoscopic Pyeloplasty

Objective To analyze the detection results of blood gas analysisafter laparoscopic pyeloplasty, and assess the influence factors andprevention measures of carbon dioxide （CO₂） pneumoperitoneum onacid-base balance in children. And evaluate the benefits，drawbacks andindication of postoperative different pelvis urine drainages.Methods①Sixty-four laparoscopic and open Anderson-Hynespyeloplasty were divided into laparoscopic group and open group. Allpatients were divided into infants group, preschool-age group andschool-age group. Twenty-six laparoscopic pyeloplasty with perioperativeintervention measure were selected as laparoscopic intervention group, inwhich peritoneal residual CO₂was completely replaced with air at the endof operation. The blood gas analysis was analysed at4hours after surgeryfor all patients. To compare the difference of hypercapnia incidencebetween laparoscopic group and open group, and that between laparoscopicgroup and laparoscopic intervention group. Moreover, the difference ofacid-base imbalance incidence with three age groups was also compared. ②Ninety laparoscopic pyeloplasty were divided into nephrostomyexternal drainage group, long-term double J catheter internal drainagegroup and short-term double J catheter internal drainage group. To comparethe difference of postoperative complications and successful rate with threegroups.Results①The hypercapnia incidence of laparoscopic group was higher than opengroup （P<0.05）, and there was no significant difference of metabolicacidosis incidence in both groups （P>0.05）.②The incidence of acid-base imbalance in both laparoscopic group andopen group was gradually decreased with increase of age. In laparoscopicgroup, the acid-base imbalance incidence of infants group was significantlyhigher than school-age group （P<0.01）, preschool-age group wassignificantly higher than school-age group （P<0.05）, but there was nosignificant difference between infants group and preschool-age group（P>0.05）. And the result of total acid-base imbalance incidence with threeage stages in open group was the same as that in laparoscopicnon-intervention group.③The hypercapnia incidence of laparoscopic intervention group waslower than laparoscopic group （P<0.05）, and there was no significantdifference of metabolic acidosis incidence in both groups （P>0.05）.④The incidence of postoperative gross hematuria in nephrostomy external drainage group was significantly lower than long-term double Jcatheter internal drainage group （P<0.01） and short-term double J catheterinternal drainage group （P<0.05）. The total incidence of postoperativecomplications in nephrostomy external drainage group was significantlylower than long-term double J catheter internal drainage group andshort-term double J catheter internal drainage group （P<0.01）. Theincidence of urinary infection in nephrostomy external drainage group wassignificantly lower than long-term double J catheter internal drainage group（P<0.05）. The incidence of drainage tube blockage and omentum prolapsusin nephrostomy external drainage group was significantly lower thanshort-term double J catheter internal drainage group （P<0.05）. And therewas no significant difference of the incidence with anastomosis obstructionin three groups （P>0.05）.⑤There was no significant difference of postoperative followed-upsuccessful rate in three groups （P>0.05）.Conclusions①The CO₂pneumoperitoneum in laparoscopic pyeloplasty is the majorinfluence factor that can cause the intraoperative hypercapnia in chidren.②Completely replacing peritoneal residual CO₂is the important measurethat can decrease the postoperative hypercapnia.③The age is younger, the effect on the acid-base balance caused by CO₂ pneumoperitoneum is greater. Especially for the infants, if perioperativemonitoring and anesthetic management is intensified, and peritonealresidual CO₂is emptied as possible after operation, the incidence ofhypercapnia caused by CO₂would be decreased.④After the laparoscopic pyeloplasty, nephrostomy external drainagecould provide the smallest trauma and the fastest recovery for children.⑤Three urine drainages have their own indication. The most suitableurine drainages could be selected by actual situation.