Comparative study of different pneumoperitoneum modes on lower extremity deep venous blood flow velocity in patients undergoing laparoscopic surgery

doi:10.3969/j.issn.1674-8115.2022.09.021

Abstract

Abstract:

Objective ·To investigate the effects of stabilized pneumoperitoneum and traditional pneumoperitoneum on the blood flow velocity of the lower extremity deep veins in the patients undergoing laparoscopic surgery. Methods ·According to the convenience sampling method, a total of 60 patients undergoing laparoscopic abdominal and pelvic malignant tumor surgeries in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from April 2021 to September 2021 were selected, and the stabilized pneumoperitoneum group (n=30) and the traditional pneumoperitoneum group (n=30) were compared at T0 (before anesthesia), T1 (after anesthesia), T2 (after pneumoperitoneum stabilization), T3 (pneumoperitoneum at 60 min), T4 (pneumoperitoneum at 120 min), and T5 (after pneumoperitoneum) in blood flow velocity including peak systolic velocity (PSV) and end diastolic velocity (EDV). The activated partial thromboplastin time (APTT), prothrombin time (PT) and D‐dimer (D-D) were detected at 24 h before and after surgery. Results ·CO₂pneumoperitoneum slowed down the blood flow velocity of lower extremity deep veins. Repeated measurement ANOVA analysis showed the values of F_time, F_groupand F_interaction were 1 253.171, 4.905 and 13.338 (P<0.05), respectively for PSV, and 1 046.798, 21.163, and 11.090, respectively for EDV (P<0.01). There were great influences on PSV and EDV in the traditional pneumoperitoneum group. With the prolongation of pneumoperitoneum time, the difference of blood flow velocity in the stabilized pneumoperitoneum group was significantly lower than that in the traditional pneumoperitoneum group at T3, T4 and T5 time points (P<0.05). There were statistically significant differences in APTT, PT and D-D between the two groups at 24 h before and after surgery (P=0.000). There was no statistical difference in the incidence of deep vein thrombosis (DVT) between the two groups (χ²=0.215, P=1.000). Conclusion ·Stabilized pneumoperitoneum and traditional pneumoperitoneum have different effects on deep venous blood flow of lower extremities. It is recommended to use stabilized pneumoperitoneum to slow down the decrease of lower limb blood flow velocity for patients undergoing a long time laparoscopic surgery.

Key words: blood flow velocity, laparoscopic surgery, pneumoperitoneum pressure, deep venous thrombosis

CLC Number:

R656

SUN Huihua, TIAN Qiuju, WU Beiwen. Comparative study of different pneumoperitoneum modes on lower extremity deep venous blood flow velocity in patients undergoing laparoscopic surgery[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(9): 1329-1335.

Figures/Tables 6

TrendMD

References 15

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Item	Control group （n=30）	Observation group （n=30）	χ²/t/Z value	P value
Gender/n （%）			0.317	0.573
Male	20 （66.7）	22 （73.3）
Female	10 （33.3）	8 （26.7）
Age/year	71.93±11.58	73.13±10.15	0.427	0.671
BMI/n （%）			0.144	0.931
Underweight（BMI<18.5 kg·m^-2）	6 （20.0）	6 （20.0）
Normal（18.5 kg·m^-2≤BMI<25 kg·m^-2）	17 （56.7）	16 （53.3）
Overweight/obesity（BMI≥25 kg·m^-2）	7 （23.3）	8 （26.7）
Hypertension/n （%）			0.278	0.792
Yes	11 （36.7）	13 （43.3）
No	19 （63.3）	17 （56.7）
Coronary heart disease/n （%）			0.111	1.000
Yes	6 （20.0）	5 （16.7）
No	24 （80.0）	25 （83.3）
Smoke/n （%）			0.480	0.731
Yes	4 （13.3）	6 （20.0）
No	26 （86.7）	24 （80.0）
ASA/n （%）			0.352	0.839
Ⅰ	2 （6.7）	2 （6.7）
Ⅱ	26 （86.7）	27 （90.0）
Ⅲ	2 （6.7）	1 （3.3）
Barthel self-care score	100 （75，100）	100 （75，100）	0.725	0.468
Caprini risk score	3.46±0.73	3.46±0.68	0.000	1.000
Albumin/（g·L^-1）	33.73±6.89	35.20±10.05	0.660	0.512
Hemoglobin/（g·L^-1）	123.33±12.23	122.40±11.84	0.300	0.765
Platelet/（×10⁹·L^-1）	204.77±72.74	180.47±62.22	1.391	0.170
Operation duration/min	169.60±37.20	159.07±30.22	1.203	0.234
Bleeding/mL	175.13±105.16	157.30±39.64	0.869	0.388
Type of surgery/n （%）			0.074	0.963
Prostate	13 （43.3）	12 （40.0）
Bladder	3 （10.0）	3 （10.0）
Colorectal	14 （46.7）	15 （50.0）

Item	Control group （n=30）	Observation group （n=30）	χ²/t/Z value	P value
Gender/n （%）			0.317	0.573
Male	20 （66.7）	22 （73.3）
Female	10 （33.3）	8 （26.7）
Age/year	71.93±11.58	73.13±10.15	0.427	0.671
BMI/n （%）			0.144	0.931
Underweight（BMI<18.5 kg·m^-2）	6 （20.0）	6 （20.0）
Normal（18.5 kg·m^-2≤BMI<25 kg·m^-2）	17 （56.7）	16 （53.3）
Overweight/obesity（BMI≥25 kg·m^-2）	7 （23.3）	8 （26.7）
Hypertension/n （%）			0.278	0.792
Yes	11 （36.7）	13 （43.3）
No	19 （63.3）	17 （56.7）
Coronary heart disease/n （%）			0.111	1.000
Yes	6 （20.0）	5 （16.7）
No	24 （80.0）	25 （83.3）
Smoke/n （%）			0.480	0.731
Yes	4 （13.3）	6 （20.0）
No	26 （86.7）	24 （80.0）
ASA/n （%）			0.352	0.839
Ⅰ	2 （6.7）	2 （6.7）
Ⅱ	26 （86.7）	27 （90.0）
Ⅲ	2 （6.7）	1 （3.3）
Barthel self-care score	100 （75，100）	100 （75，100）	0.725	0.468
Caprini risk score	3.46±0.73	3.46±0.68	0.000	1.000
Albumin/（g·L^-1）	33.73±6.89	35.20±10.05	0.660	0.512
Hemoglobin/（g·L^-1）	123.33±12.23	122.40±11.84	0.300	0.765
Platelet/（×10⁹·L^-1）	204.77±72.74	180.47±62.22	1.391	0.170
Operation duration/min	169.60±37.20	159.07±30.22	1.203	0.234
Bleeding/mL	175.13±105.16	157.30±39.64	0.869	0.388
Type of surgery/n （%）			0.074	0.963
Prostate	13 （43.3）	12 （40.0）
Bladder	3 （10.0）	3 （10.0）
Colorectal	14 （46.7）	15 （50.0）

Group	n	T0	T1	T2	T3	T4	T5
Control	30	20.92±2.92	13.44±2.50	7.90±0.79	5.58±0.46	4.33±0.60	11.04±0.64
Observation	30	19.93±1.30	13.04±1.53	7.62±0.64	6.51±0.69	5.65±0.66	12.83±1.61

Group	n	T0	T1	T2	T3	T4	T5
Control	30	20.92±2.92	13.44±2.50	7.90±0.79	5.58±0.46	4.33±0.60	11.04±0.64
Observation	30	19.93±1.30	13.04±1.53	7.62±0.64	6.51±0.69	5.65±0.66	12.83±1.61

Group	n	T0	T1	T2	T3	T4	T5
Control	30	18.32±2.88	12.00±1.80	6.84±0.97	4.74±0.62	3.87±0.62	10.17±0.84
Observation	30	17.74±1.63	12.53±1.45	7.23±0.87	6.00±0.79	5.15±0.46	12.40±1.22