Bekir SARICIK, Y. Savaş KOCA, Ö. Rıdvan TARHAN

Karbondioksit ile Oluşturulan Pnömoperitoneumun Periton Yapısı Üzerine Etkileri

Giriş : Laparoskopik ameliyatların uygulanmaya başlamasıyla beraber pnömoperiton oluşturmak için birçok gaz denenmiştir. Bunlar arasında halen en yaygın kullanımda olan karbondioksit gazıdır. karbondioksit ile oluşturulan pnömoperiton laparoskopik ameliyatlarda cerrahlara uygun alan oluşturmasına rağmen peritoneal yapı üzerinde birtakım istenmeyen değişikliklere de sebep olmaktadır. Bu yan etkilerden bazıları kaçınılmaz olmasına rağmen bazı yan etkilerde uygulama şekline bağlı değişiklik gösterebilmektedir .Metod: Karbondioksit ile oluşturulan pnömoperitonun peritoneal yapı üzerine etkilerine ilişkin literatürdeki yapılan deneysel ve klinik çalışmalar dikkate alınarak bu derleme hazırlandı. Sonuçlar : Pnomöperiton oluşumu peritoneal çevreyi ve dolayısıyla organizmayı etkiler. Bu etkilenim intraabdominal basınç artışı, karbondioksitin lokal peritoneal destrüktif etkileri, karbondioksit emilimi ve kimyasal metabolik değişimler gibi sebeplerle olmaktadır. İnsuflasyon hızı ve basıncı genel olarak hemodinamik değişiklikler yapmaktadır. Karbondioksitin hipoksiketkisi, toksik etkisi, kuruluğu,soğukluğu peritoneal çevrenin yapısal bozulmasına sebep olmaktadır. Tartışma : laparoskopik cerrahi hergeçen gün daha da yaygınlaşmaktadır. Bu ndenle özellikle ek hastalığı olan ya da obez hastalarda pnömoperitonun yaptığı etkiler hakkında farkındalığa sahip olunması önemlidir. Bu farkındalık hastaların pnömoperitonun yaptığı istenmeyen değişikliklerden etkilenimini azaltacağı kanısındayız.

Anahtar Kelimeler:

karbondioksit pnömoperitoneum, laparoskopi, karbondioksit insuflasyon

The Effects of Carbon Dioxide Pneumoperitoneum on Peritoneal Structure

Background: To create pneumoperitoneum at the beginning of laparoscopic surgery, several gases have been trialled. The most commonly used of these gases is carbon dioxide. Although pneumoperitoneum created with carbon dioxide provides an appropriate area for surgeons to perform laparoscopic operations, it can also cause several unwanted changes to the peritoneal structure. Some of these side-effects are inevitable but some exhibit changes depending on the method of application. Methods: This review was prepared taking into consideration the previous experimental and clinical studies in literature related to the effects on the peritoneal structure of pneumoperitoneum created with carbon dioxide. Results: The creation of pneumoperitoneum affects the peritoneal environment and thereby the organism. This effect is caused by increased intra-abdominal pressure, the local peritoneal destructive effect, carbon dioxide absorption and chemical metabolic changes. The insufflation rate and pressure generally make haemodynamic changes. The hypoxic effect of carbon dioxide, the toxic effect, the dryness and the coldness may cause structural impairment of the peritoneal environment. Conclusions: Laparoscopic surgery is becoming more widespread. Therefore, it is important to be aware of the effects created by pneumoperitoneum, especially in obese patients or those with concomitant diseases. With this awareness, it will be possible to reduce the effects of the undesired changes wrought by pneumoperitoneum.

Keywords:

Carbon dioxide pneumoperitoneum laparoscopy, , carbon dioxide insufflation,

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