Abstract:
Objective:To investigate the effect of elevated CO2 intraabdominal pressure on acute gastrointestinal injury (AGI) during laparoscopic colorectal surgery. 〖HQK〗
Methods:The clinical data of 66 patients who underwent laparoscopic colorectal surgery at the Ruijin Hospital of Shanghai Jiaotong University School of Medicine from January 2014 to June 2014 were prospectively analyzed. A double blind, randomized, controlled study was performed in the 66 patients who were allocated into the 10 mmHg group (1 mmHg=0.133 kPa), 12 mmHg group and 15 mmHg group based on a random number table and setting value of intraoperative CO2 intraabdominal pressure (10 mmHg, 12 mmHg and 15 mmHg). The main observation indicators such as intraoperative conditions and postoperative recovery were recorded and the levels of serum IL-6 and TNFα were detected. Measurement data with normal distribution were presented as
±s, and comparison among groups was analyzed using the oneway ANOVA. Nonnormal distribution data were described as M(Qn) and analyzed by the nonparametric test, count data were presented as the frequency and percentage, and comparison among groups was analyzed using the chisquare test.
Results: Sixtysix patients were screened for eligibility, and were allocated into the 10 mmHg group, 12mmHg group and 15mmHg group (22 patients in each group), and 11 patients dropped out of the study (3 in the 10 mmHg group, 3 in the 12 mmHg group and 5 in the 15 mmHg group). The number of patients with nasogastric tube removal within postoperative hour 6 in the 3 groups were 19, 18 and 14, with no significant difference among the 3 groups (χ
2=3.55, P>0.05). There were 0, 1 and 2 patients in the 3 groups complicated with postoperative early abdominal complications without AGI, showing no significant difference among the 3 groups (χ
2=5.82, P>0.05), and they were cured by the conservative treatment without reoperation in the short term. Fifteen patients had AGI, including 8 with grade Ⅰ of AGI and 7 with grade Ⅱ of AGI. The incidence ratio of AGI and number of patients with grade Ⅰ and grade Ⅱ of AGI were 6/19, 2 and 4 in the 10 mmHg group, 3/19, 2 and 1 in the 12 mmHg group and 6/17, 4 and 2 in the 15 mmHg group, respectively, with no significant difference among the 3 groups (χ
2=2.04, 2.00, P>0.05). The incidence ratio of postoperative intestinal paralysis, time of intestinal peristalsis recovery, time to anal exsufflation or defecation, tolerant time for semifluid diet intake, number of patients with postoperative vomiting, number of patients with postoperative diarrhea and duration of hospital stay were 4/19, (37±25)hours, 31.3 hours(16.8 hours, 45.6 hours), 142.3 hours(118.9 hours, 144.9 hours), 1, 5, 8 days(8 days, 9 days) in the 10 mmHg group, 3/19, (26± 16)hours, 40.8 hours(20.9 hours, 64.5 hours), 137.4 hours(118.7 hours, 143.4 hours), 1, 3, 8 days (8 days, 9 days) in the 12 mmHg group and 4/17, (33±12)hours, 31.9 hours(20.8 hours, 51.0 hours), 139.5 hours (119.1 hours, 145.5 hours), 1, 4, 8 days(8 days, 10 days) in the 15 mmHg group, respectively, showing no significant difference among the 3 groups (χ
2=0.46, F=1.64, χ
2=1.22, 1.27, 0.01, 0.76, 0.90, P>0.05). The levels of serum IL-6 in the 10 mmHg group, 12 mmHg group and 15 mmHg group were 2.0 ng/L(2.0 ng/L, 2.7 ng/L), 2.8 ng/L(2.0 ng/L, 5.9 ng/L) and 2.1 ng/L(2.0 ng/L, 3.0 ng/L) before operation and 10.7 ng/L(7.5 ng/L, 17.7 ng/L), 11.3 ng/L(5.4 ng/L, 14.5 ng/L) and 9.4 ng/L(6.7 ng/L, 18.2 ng/L) at postoperative day 1, respectively, with significant differences between pre and postoperative levels of serum IL-6 among the 3 groups (Z=-3.93,-3.46,-4.12, P<0.05), with no significant differences in the postoperative levels and increasing range of serum IL-6 among the 3 groups (χ
2=0.43, 2.65, P>0.05). The pre and postoperative levels of serum TNFα in the 10 mmHg group, 12 mmHg group and 15 mmHg group were 9.5 ng/L(7.4 ng/L, 10.7 ng/L), 9.4 ng/L(8.5 ng/L, 13.4 ng/L), 8.5 ng/L(7.8 ng/L, 9.5 ng/L) and 9.0 ng/L(8.5 ng/L, 12.5 ng/L), 10.3 ng/L(7.8 ng/L, 12.0 ng/L), 8.2 ng/L(6.4 ng/L, 12.2 ng/L), respectively, with no significant differences in the pre and postoperative levels of serum TNFα among the 3 groups (Z=-1.10,-0.02,-0.68, P>0.05), and with no significant difference in the postoperative levels of serum TNFα among the 3 groups (χ
2=2.61, P>0.05). The levels of serum IL-6 were 10.7 ng/L(6.8 ng/L, 14.7 ng/L)in 11 patients with postoperative intestinal paralysis and 10.6 ng/L(6.9 ng/L, 18.1 ng/L) in 44 patients without postoperative intestinal paralysis, with no significant difference (Z=-0.03, P>0.05).
Conclusion:There is no correlation between elevated CO2 intraabdominal pressure and AGI after laparoscopic colorectal surgery. Registry: This study was registered with the Chinese Clinical Trial Registry with the registry number of ChiCTRTRC13003292.
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