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首页> 外文期刊>Surgical Endoscopy >Laparoscopic insufflation of the abdomen reduces portal venous flow (see comments)
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Laparoscopic insufflation of the abdomen reduces portal venous flow (see comments)

机译：腹腔镜腹部吹气减少门静脉血流（见评论）

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摘要

BACKGROUND: The adverse effects of sustained elevated intraperitoneal pressure (IPP) on cardiovascular, pulmonary and renal systems have been well documented by several reported experimental and clinical studies. Alteration in the splanchnic circulation has also been reported in animal experiments, but details of the exact hemodynamic changes in the flow to solid intraabdominal organs brought on by a raised intraperitoneal pressure in the human are not available. The aim of the present study was to estimate effect of increased IPP on the portal venous flow, using duplex Doppler ultrasonography in patients undergoing laparoscopic cholecystectomy. METHODS: The studies were performed using the SSD 2000 Multiview Ultrasound Scanner and the UST 5536 7.0-MHz laparoscopic transducer probe. Details of the measurements were standardized in according to preset protocol. Statistical evaluation of the data was conducted by the two-way analysis of variance (ANOVA). RESULTS: The flow measurement data have demonstrated a significant (p < 0.001) decrease in the portal flow with increase in the intraperitoneal pressure. The mean portal flow fell from 990 +/- 100 ml/min to 568 +/- 81 ml/min (-37%) at an IPP of 7.0 mmHg and to 440 +/- 56 mmHg (-53%) when the IPP reached 14 mmHg. CONCLUSIONS: The increased intraperitoneal pressure necessary to perform laparoscopic operations reduces substantially the portal venous flow. The extent of the volume flow reduction is related to the level of intraperitoneal pressure. This reduction of flow may depress the hepatic reticular endothelial function (possibly enhancing tumor cell spread). In contrast, the reduced portal flow may enhance cryoablative effect during laparoscopic cryosurgery for metastatic liver disease by diminishing the heat sink effect. These findings suggest the need for a selective policy, low pressure or gas-less techniques to positive-pressure interventions, during laparoscopic surgery in accordance with the disease and the therapeutic intent.
机译：摘要背景：持续的腹膜内高压（IPP）对心血管，肺和肾系统的不良影响已被一些报道的实验和临床研究充分证实。在内脏循环中的变化也已在动物实验中报告，但尚无因人腹膜内压力升高而导致流向实腹腔器官的确切血流动力学变化的详细信息。本研究的目的是在接受腹腔镜胆囊切除术的患者中使用多普勒超声检查来评估IPP升高对门静脉血流的影响。方法：使用SSD 2000 Multiview超声扫描仪和UST 5536 7.0 MHz腹腔镜探头进行了研究。根据预设的协议对测量的细节进行了标准化。数据的统计评估通过方差的双向分析（ANOVA）进行。结果：流量测量数据表明，随着腹膜内压力的增加，门脉流量显着减少（p <0.001）。 IPP为7.0 mmHg时，平均门静脉血流量从990 +/- 100 ml / min降至568 +/- 81 ml / min（-37％），而IPP时降至440 +/- 56 mmHg（-53％）达到14毫米汞柱。结论：执行腹腔镜手术所需的腹膜内压力的增加大大减少了门静脉的流动。体积流量减少的程度与腹膜内压力水平有关。这种流量减少可能会降低肝网状内皮功能（可能增强肿瘤细胞的扩散）。相反，减少的门脉血流可通过减少散热器的作用来增强腹腔镜冷冻手术治疗转移性肝病时的冷冻消融作用。这些发现表明，根据疾病和治疗目的，在腹腔镜手术期间需要对正压干预措施采取选择性策略，低压或无气技术。

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