2024-03-28
Ⅰ. Subcutaneous emphysema
Subcutaneous emphysema is the most common pneumoperitoneum complication, and the incidence of subcutaneous emphysema is as high as 2.7%.
1. Common reasons
(1) Patient factors: patient weight and thickness of subcutaneous fat are closely related to the occurrence of subcutaneous emphysema, mainly due to the lack of subcutaneous adipose tissue in extremely emaciated patients, the weak blocking effect of adipose tissue on gas, and the rapid diffusion of gas along the subcutaneous to form subcutaneous emphysema.
(2) Puncture technique, pneumoperitoneum needle is located in the extraperitoneal space: During the establishment of pneumoperitoneum needle blind penetration, the patient was obese and the abdominal wall was thick, the needle did not enter the abdominal cavity and injected gas, which directly formed subcutaneous emphysema.
(3) Due to the complicated operation and long operation time, frequent replacement of instruments and removal of puncture apparatus increased the occurrence of subcutaneous emphysema.
2. Performance
(1) In mild cases, the skin around the casing is swollen, and there is a feeling of twisting or holding snow when pressed:
(2) In severe cases, the skin swelling is more obvious and extensive, spreading up and down along the chest and abdominal wall, reaching the neck, head and face, down the perineum and lower limbs (men can appear scrotal emphysema), which can lead to hypercapnia, acidosis, and even cardiopulmonary dysfunction;
(3) The injection of little star gas but quickly reach high pressure or abdominal expansion is not uniform, percussion drum sound is not obvious should be highly suspected that the pneumoperitoneum needle is located in the extraperitoneum.
3. Prevention and treatment
① During the operation, the