腹腔镜手术麻醉.pptVIP

19901991199219931994199519961997200120020306090120150180210240OpenLaparoscopicOpenportion33%19901991199219931994199519961997200120020306090120150180210240OpenLaparoscopicOpenportion13%微创腔镜手术在中国燎原发展普及SurgeonUrologistGynecologistDiagnosticIntestinalHerniotomyLiverSpleenFundioplicationCholecystectomyEsophagusAxillarlymphonodesGastricbandingAdrenalectomyParathyreoidectomyDiagnosticNephrectomyKidneycystsProstatectomyVaricoceleLymphadenectomyTesticulardescensusDiagnosticTubarligationAdnexectomyOvarectomyLymphadenectomyEndometriosisMyomectomyAxillarlymphonodes对麻醉的要求与挑战气腹1.气肿2.气胸3.气体栓塞4.对通气的改变5.高碳酸血症6.对血流动力学的反应7.局部血流动力学的影响8.心率失常9.反流误吸10.肩部酸痛对肺功能影响OrganSystemPhysiologicEffectPotentialOutePulmonary?peakairwaypressure?pulmplianceSuperiordisplacementofdiaphragm?end-tidalCO2Barotrauma?pCO2or?pO2?pCO2or?pO2Acidosis对心血管功能影响OrganSystemPhysiologicEffectPotentialOuteCirculatoryDirecteffects-?CVP,CWP,SVR(afterload),MAPIndirecteffects–arteriolardilationandmyocardialdepressionIndirecteffects–sympathetics,renin-angiotensin?cardiacwork?bloodpressure?Bloodpressureandcardiacoutput?Urineoutput?*Inourhospital,laparscopicabdominalsurgeryonalargerscalewasintroducedinthenienties.Alreadyin1991onlyhalfofthecholecytectomieswereperformedthroughanopenaccess,whileoverthefollowing5yearsthisportiondecreasedto33%,finallyendingupatonly13%in2002.****Thelistofinterventionsthatcanbeperformedviaendoscopyhasbeengrosslyexpanded.Thisisduetocountinuousadditionofvisceralsurgical,urologicalandgynecologicalinterventionsthataredevelopedandaccreditedtobefeasibleforthiskindofproceeding.移植外科微创外科修复外科肿瘤的分子生物学治疗一、腔镜手术的发展背景Hippocrates伟大思想的提出-----公元前460-377提出借助某种手段窥视和检查直肠病变开创了诊断与治疗的新天地现代腹腔镜的起源Georgkelling1901年，德国的外科医师Georgkelling在狗的腹腔内插入一根膀胱镜,并用空气制造