妊娠期的腹腔镜手术

• 作 者: 曾学敏
• 机 构: 首都医科大学附属北京妇产医院 北京100006
• 出 处: 实用妇产科杂志
• 发表日期: 2004年03期
• 关键词: 腹腔镜手术 气腹压 手术指征 子宫损伤 套管针穿刺 换气功能 妊娠中期 肺通气 腔镜 手术时间

如果手术指征明确 ,在妊娠的各个时期均可进行腹腔镜手术 ,其中最安全的是妊娠中期。术中应避免使用有争议的麻醉药 ,如笑气。为减少子宫损伤 ,可采用开放法 (Hosson法 )行第 1套管针穿刺。为避免胎儿酸中毒 ,应尽可能降低CO2 气腹压 ,保证母体充足的肺通气量和换气功能 ,一般将CO2 气腹压设置在 15mmHg以下 ,呼气末CO2 分压维持在 32～ 35mmHg。

If the indications for surgery are clear, laparoscopic surgery can be performed at all stages of pregnancy, the safest of which is in the second trimester. Intraoperative use of controversial anesthetics such as nitrous oxide should be avoided. In order to reduce uterine injury, we can use open method (Hosson method) to perform the first trocar puncture. In order to avoid fetal acidosis, CO2 pneumoperitoneum pressure should be reduced as much as possible to ensure adequate pulmonary ventilation and ventilation function of the mother. The CO2 pneumoperitoneum pressure is generally set below 15 mmHg and the end-expiratory CO2 partial pressure is maintained at 32 to 35 mmHg.