Effects of different CO2 pneumoperitoneum pressure on intestinal mucosal injury and intestinal function recovery in patients with early and locally advanced gastric cancer during D2 radical gastrectomy for gastric cancer

Abstract

Objective To analyze the effect of different CO2 pneumoperitoneum pressure on intestinal mucosal injury and intestinal function recovery in patients with early and locally advanced gastric cancer undergoing laparoscopic D2 radical gastrectomy for gastric cancer. Methods 200 patients with early and locally advanced gastric cancer who were treated surgically in our hospital from February 2016 to February 2018 were selected as the research subjects. Among them, 79 cases underwent open D2 radical gastrectomy (group A), and 121 cases underwent laparoscopic D2 radical gastrectomy for gastric cancer (group B). In group B, according to the difference of CO2 pneumoperitoneum pressure, 121 cases were divided into low-degree group [CO2 pneumoperitoneum pressure for 8-10 mmHg (1 mmHg = 0.133 kPa)], moderate-degree group (CO2 pneumoperitoneum pressure for 11-13 mmHg), and high-degree group (CO2 pneumoperitoneum pressure for 14-16 mmHg). The degree of intestinal mucosal injury, the occurrence of complications, the time of postoperative hospitalization, and the recovery of intestinal function were compared among groups. Results The degree of intestinal mucosal injury in group A was lighter; while in group B, the degree of intestinal mucosal injury in severe group was more severe than that in mild group and moderate group. The incidence of complications in group B (2.48%) was significantly lower than that in group A (25.32%) (P 0.05), but it was significantly longer than that in the mild group [(4.98±0.47)d] and the moderate group [(7.05±1.14)d] (P<0.05). The postoperative exhaust time [(5.47±0.99)d], bowel sounds appear time [(4.58±1.24)d] and eating time [(6.14±1.27)d] in severe group were longer than those in the other groups (P<0.05). Conclusions Laparoscopic D2 radical gastrectomy for gastric cancer has the advantages of less invasive and safe for the treatment of early and locally advanced distal gastric cancer, but if CO2 pneumoperitoneum pressure is high, it is easy to cause postoperative intestinal mucosal injury, besides the recovery of intestinal function is extremely unfavorable. So in radical resection, when ensuring clear surgical field conditions, the pressure of CO2 pneumoperitoneum should be reduced as far as possible. Key words: Laparoscopy; Radical operation; Gastric cancer; Pneumoperitoneum pressure; Intestinal mucosa; Intestinal function