腹腔镜手术皮下气肿危险因素与防治

doi:10.3877/cma.j.issn.2095-3232.2025.04.021

腹腔镜手术皮下气肿的发生率低，但严重皮下气肿可导致广泛的皮下组织感染、腹壁蜂窝织炎和二氧化碳气体栓塞，延长住院时间并影响患者预后，甚至危及患者生命。腹腔镜手术皮下气肿的危险因素包括患者年龄>65岁、BMI<25 kg/m²、Trocar穿刺位置与术区距离过远、穿刺方向与术区方向角度过大、Trocar反复移位、手术切口>4个、手术时间>6 h、高气体流速与腹内压、机器人手术等。外科医师需识别高危人群，谨慎对待每一次手术，总结手术经验，改善患者预后。本综述旨在阐述腹腔镜手术皮下气肿的危险因素，以防治皮下气肿发生，降低手术风险。

关键词: 腹腔镜, 皮下气肿, 危险因素, 高碳酸血症, 腹内压, 机器人腹腔镜手术, 体质量指数

Although the incidence of subcutaneous emphysema in laparoscopic surgery is low, severe subcutaneous emphysema can lead to extensive subcutaneous tissue infection, abdominal wall cellulitis and carbon dioxide embolism, which can prolong the length of hospital stay, affect clinical prognosis and even threaten patients’ lives. The risk factors of subcutaneous emphysema in laparoscopic surgery include patients aged>65 years, BMI<25 kg/m², excessively long distance between the puncture site of Trocar and surgical site, excessively large angle between the direction of puncture and that of surgical site, repeated displacement of Trocar, number of surgical incision>4, operation time>6 h, high gas flow rate and intra-abdominal pressure, and robot-assisted surgery, etc. Surgeons should identify high-risk populations, perform each surgery cautiously, summarize surgical experience and improve clinical prognosis of patients. In this article, the risk factors of subcutaneous emphysema in laparoscopic surgery were reviewed, aiming to prevent the incidence of subcutaneous emphysema and reduce the risk of surgery.

Key words: Laparoscopy, Subcutaneous emphysema, Risk factors, Hypercapnia, Intra-abdominal pressure, Robotic laparoscopic surgery, Body mass index

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Risk factors, prevention and treatment of subcutaneous emphysema in laparoscopic surgery

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