探讨免气腹腹腔镜与气腹腹腔镜在食管裂孔疝修补术对呼吸循环系统的影响。

选择2014年3月至2015年5月，美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级，新疆维吾尔自治区人民医院拟在全身麻醉插管下行食管裂孔疝手术的患者30例，采用随机数字法分为免气腹组(A组)和气腹组(B组)。观察并记录患者患者安静状态(T0)、手术开始时(T1)、手术开始后15 min(T2)、缝皮或解除气腹后5 min(T3)各时间点PETCO₂、气道峰压并采集动脉血进行血气分析，并记录术后并发症的情况。

两组患者术中各时间点PaO₂、PETCO₂、气道峰压的比较，差异有统计学意义(P<0.05)，B组各时间点氧分压较A组低(P<0.05)，而PETCO₂、气道峰压较A组高(P<0.05)；B组患者术中T2、T3时点SBP、DBP比A组高(P<0.05)；A组患者术后切口疼痛及肩部酸痛发生率较B组低(P<0.05)。

免气腹腹腔镜下食管裂孔疝修补手术是一种安全有效的手术方式，与气腹腹腔镜相比对呼吸、循环系统影响更少，且术后切口疼痛和肩部酸痛发生率更低。

To investigate the effects of non-pneumoperitoneum laparoscopic repair-procedure ofesophageal hiatal hernia on Respiratory and Circulatory system and postoperative complication.

During March 2014 to May 2015, thirty patients from People′s Hospital of Xinjiang Uygur Autonomous Region(ASA grade I or II)scheduled for elective laparoscopic repair-procedure ofesophageal hiatal hernia, were randomly divided into group A and B with 15 cases each.Group A is non-pneumoperitoneum group, Group B is pneumoperitoneum group.After induction of anesthesia, ventilation was performed with tidal VT 10 ml/kg, respiratory rate(RR)12 breaths per minute(BPM), ratio of inspiratory to expiratory(I: E)was 1: 2.The time of 10 minutes after entering operating room as T0, The time of operation begining as T1, The time of 15 minutes after starting operation as T2 in group A, The time of 15 minutes after making Carbon dioxide pneumoperitoneum as T2 in group B, The time of skin staple or relieve pnellmoperitoneum as T3.To collect blood for laboratory examination at T0, T1, T2, T3 respectively, and record vital sign.

Compared with group A, Group B have lower PaO₂ and higher end-tidal pressure of carbon dioxide and peak pressure of airway(P<0.05). The incidence of shonlder soreness and cut pain was lower in group A(P<0.05).

Compared with pneumoperitoneum laparoscopic repair-procedure ofesophageal hiatal hernia, non-pneumoperitoneum laparoscopic repair-procedure ofesophageal hiatal hernia maintained a steady circulation which more conduciveto the oxygenation.And the recovery of gastrointestinal tract functions were faster.