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首页> 外文期刊>Surgical Endoscopy >The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery.
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The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery.

机译：欧洲内窥镜手术协会有关腹腔镜手术气腹的临床实践指南。

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BACKGROUND: The pneumoperitoneum is the crucial element in laparoscopic surgery. Different clinical problems are associated with this procedure, which has led to various modifications of the technique. The aim of this guideline is to define the scientifically proven standards of the pneumoperitoneum. METHODS: Based on systematic literature searches (Medline, Embase, and Cochrane), an expert panel consensually formulated clinical recommendations, which were graded according to the strength of available literature evidence. RECOMMENDATIONS: Preoperatively, all patients should be assessed for the presence of cardiac, pulmonary, hepatic, renal, or vascular comorbidity. Presupposing appropriate perioperative measures and surgical technique, there is no reason to contraindicate pneumoperitoneum in patients with peritonitis or intraabdominal malignancy. During laparoscopy, monitoring of end tidal CO2 concentration is mandatory. The available data on closed- (Veress needle) and open-access techniques do not allow us to principally favor the use of either technique. Using 2 to 5-mm instead of 5 to 10-mm trocars improves cosmetic result and postoperative pain marginally. It is recommended to use the lowest intraabdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure. In patients with limited cardiac, pulmonary, or renal function, abdominal wall lifting combined with low-pressure pneumoperitoneum might be an alternative. Abdominal wall lifting devices have no clinically relevant advantages compared to low-pressure (5-7 mmHg) pneumoperitoneum. In patients with cardiopulmonary diseases, intra- and postoperative arterial blood gas monitoring is recommended. The clinical benefits of warmed, humidified insufflation gas are minor and contradictory. Intraoperative sequential intermittent pneumatic compression of the lower extremities is recommended for all prolonged laparoscopic procedures. For the prevention of postoperative pain a wide range of treatment options exists. Although all these options seem to reduce pain, the data currently do not justify a general recommendation.
机译：背景：气腹是腹腔镜手术中的关键要素。该过程与不同的临床问题相关，从而导致了该技术的各种修改。本指南的目的是定义经科学证明的气腹标准。方法：在系统的文献检索（Medline，Embase和Cochrane）的基础上，专家小组根据意见制定了临床建议，并根据现有文献证据的强度进行了分级。建议：术前，应评估所有患者的心脏，肺，肝，肾或血管合并症。假设适当的围手术期措施和手术技术，没有理由在腹膜炎或腹腔内恶性肿瘤患者中禁忌气腹。在腹腔镜检查期间，必须监测潮气末二氧化碳浓度。关于闭合（Veress针）和开放式技术的可用数据不允许我们从原则上赞成使用这两种技术。使用2到5毫米而不是5到10毫米的套管针可以改善美容效果，并略微改善术后疼痛。建议使用最低的腹腔内压力，以充分暴露手术区域，而不是使用常规压力。在心脏，肺或肾功能有限的患者中，腹壁抬高结合低压气腹可能是另一种选择。与低压（5-7 mmHg）气腹相比，腹壁举升装置没有临床相关优势。对于心肺疾病患者，建议进行术中和术后动脉血气监测。加热，加湿的吹入气体的临床益处很小且相互矛盾。对于所有长时间的腹腔镜手术，建议进行术中连续下肢间歇性气压压缩。为了预防术后疼痛，存在多种治疗选择。尽管所有这些选择似乎都减轻了痛苦，但目前的数据尚不足以作为一般性建议的理由。

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