How to choose a suitable intraabdominal pressure level during single-incision laparoscopic surgery in children

Abstract Laparoscopic surgery has become a common procedure in pediatric patients. However, adverse hemodynamic changes such as the increase of intraabdominal pressure (IAP) may occur laparoscopic surgery. The aim of this study is find a method to set a suitable IAP level in children before laparoscopic surgery. From Jan 2012 to Dec 2014, data were collected from a total of 1776 children needing laparoscopic high ligation of hernia sac. A retrospective data analysis was performed using a new defined variant Index A which had information of age, body mass index (BMI) and duration of pneumoperitoneum. The blood pressures (SBP and DBP) and the PaCO2 were increased but SV showed no changes in patients after CO2 insufflation. The complications were found in 32 cases including 2 cases with subcutaneous emphysemarelated to the CO2 insufflation directly, 3 cases of respiratory infection, 5 cases of incision infection and 2 cases of urinary tract infection) and technique related. Furthermore, the risks of complications were negatively associated with the Index A. An IAP can be optimal set up in laparoscopic high ligation of hernia sac by using the Index A.

摘要：腹腔镜手术现已成为儿科患者的常用术式。然而，腹腔镜手术期间可能出现不良血流动力学变化，例如腹腔内压（intraabdominal pressure, IAP）升高。本研究旨在探索一种可在儿童腹腔镜手术前确定适宜腹腔内压水平的方法。
2012年1月至2014年12月，共收集1776名需接受腹腔镜疝囊高位结扎术儿童的临床数据。本研究采用新定义的变异指数A（涵盖年龄、体质量指数（body mass index, BMI）及气腹持续时长相关信息）开展回顾性数据分析。经CO₂气腹灌注后，患者的收缩压（systolic blood pressure, SBP）、舒张压（diastolic blood pressure, DBP）及动脉血二氧化碳分压（PaCO₂）均升高，但每搏输出量（stroke volume, SV）无明显变化。
共32例患者出现并发症：其中2例为直接与CO₂气腹灌注相关的皮下气肿，3例为呼吸道感染，5例为切口感染，2例为尿路感染，另有与操作技术相关的并发症。此外，并发症发生风险与指数A呈负相关。通过指数A可确定腹腔镜疝囊高位结扎术中的最优腹腔内压设置方案。