Fonction respiratoire postopératoire et cholécystectomie par voie cœlioscopique

Abstract

Open cholecystectomy is associated with characteristic changes in pulmonary function showing a restrictive pattern. Laparoscopic cholecystectomy without opening of the peritoneal cavity could be an alternative in reducing postoperative respiratory dysfunction. Having given their informed consent, 13 healthy ASA1 patients (age : 41 ± 18 yrs) undergoing laparoscopic cholecystectomy were enrolled in this study, in order to assess their postoperative pulmonary function tests (forced vital capacity [FRC], forced expiratory volume [FEV 1], functional residual capacity [FRC]) before operation (T0) and 4 h (T4), 24 h (T24), 48 h (T48) after surgery. Anaesthesia technique was the same associating propofol-atracurium-fentanyl, 50 % N 2O/O 2. Ventilation was adapted to maintain end-tidal carbon dioxide pressure up to 30–35 mmHg. Postoperative analgesic regimen consisted of paracetamol-ketoprofen. Mean length of surgery was 84 ± 15 min ; mean duration of anaesthesia was 110 ± 24 min. An immediate and harmonious restrictive breathing pattern developed postoperatively. Postoperative FVC measured 65 % (T4), 63 % (T24), 72 % (T48) of preoperative function (p < 0.025) ; postoperative FEV 1 measured respectively 60, 66 and 75 % of preoperative function (p > 0.001), without change in FEV 1/CV and FRC ; a significant hypoxia occurred (T0 : 86 mmHg, T4: 80 mmHG, T24 : 75 mmHg, T48 : 81 mmHg [p < 0.05]). Laparoscopic cholecystectomy resulted in less postoperative respiratory dysfunction than conventional cholecystectomy, as previously reported ; this restrictive pattern observed without changes in FRC was similar to that following lower abdominal surgery.