可视穿刺套管在腹部术后再次行腹腔镜肝脏手术中的应用

吴香安; 石岳; 万雪帅; 王珏; 张宇珂; 金保; 刘晓; 徐海峰; 郑永昌; 卢欣; 毛一雷; 桑新亭; 杜顺达

doi:10.3969/j.issn.1001-5256.2021.10.024

可视穿刺套管在腹部术后再次行腹腔镜肝脏手术中的应用

DOI: 10.3969/j.issn.1001-5256.2021.10.024

a.
中国医学科学院北京协和医院肝脏外科，北京 100730
b.
中国医学科学院北京协和医院手术室，北京 100730

基金项目:

中国医学科学院创新医疗基金 (CAMS-2017-I2M-4-002);

国家自然科学基金 (81972698);

湖北陈孝平科技发展基金 (CXPJJH11900001-2019215)

详细信息

通信作者:
杜顺达，dushd@pumch.cn

中图分类号: R657.3
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出版历程
- 收稿日期: 2021-03-04
- 录用日期: 2021-05-31
- 出版日期: 2021-10-20

Application of optical trocar insertion in laparoscopic surgery after previous abdominal surgery

a.
Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
b.
Department of Operating Room, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China

Research funding:

CAMS Initiative of Innovative Medicine (CAMS-2017-I2M-4-002);

National Natural Science Foundation of China (81972698);

Chen Xiao-ping Foundation for the Development of Science and Technology of Hubei Porvince (CXPJJH11900001-2019215)

摘要

摘要: 目的探究可视穿刺套管建立气腹在腹部术后再次腹腔镜手术中的应用价值。方法纳入北京协和医院2017年5月—2019年5月既往有腹部手术史的拟行腹腔镜肝脏手术的患者共29例，随机分为可视穿刺套管建立气腹组及开放方式建立气腹组。符合正态分布的计量资料组间比较采用独立样本t检验；非正态分布的计量资料组间比较采用Mann-Whitney U检验；计数资料组间比较采用Fisher精确检验，等级资料组间比较采用Mann-Whitney U检验。结果两组均没有相关并发症的发生。可视组需要穿刺时间较开放组明显缩短[35.00(21.00~46.00)s vs 180.00(152.50~252.50)s，U=0，P＜0.001]。可视组观察孔切口大小明显小于开放组[1.10(1.00~1.20)cm vs 2.80(2.45~3.00)cm，U=0，P＜0.001]。结论对既往有腹部手术史的患者再次行腹腔镜肝脏手术，采用可视穿刺套管建立气腹或开放方式建立气腹都是相对安全的，但可视穿刺套管方式建立气腹更高效且微创。
- 腹腔镜检查 /
- 组织黏连 /
- 气腹, 人工
Abstract: Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery. Methods A total of 29 patients, with a history of abdominal surgery, who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group. The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of ranked data between groups. Results There were no procedure-related complications in either group. Compared with the open approach group, the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum [35.00 (21.00-46.00) seconds vs 180.00 (152.50-252.50) seconds, U=0, P < 0.001] and a significantly smaller incision length [1.10(1.00-1.20) cm vs 2.80(2.45-3.00) cm, U=0, P < 0.001]. Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery, while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.
- Laparoscopy /
- Tissue Adhesions /
- Pneumoperitoneum, Artificial

HTML全文

图 1 可视组建立气腹

注：选取合适的操作孔位置，切开皮肤后，在可视套管穿刺器内置腹腔镜直视下，通过旋转逐层通过各层腹壁组织而进入腹腔。

下载: 全尺寸图片幻灯片

图 2 开放组建立气腹

注：选取合适的观察孔位置，切开皮肤，通钝性/锐性遂层分离腹壁各层组织进入腹腔，使穿刺套管置入腹膜腔，用巾钳或缝合关闭多余的腔隙。

下载: 全尺寸图片幻灯片

表 1 两组患者一般资料比较

指标	可视组(n=15)	开放组(n=14)	统计值	P值
年龄(岁)	58.27±9.23	58.36±10.72	t=-0.024	0.981
男[例(%)]	9(60.0)	5(35.7)		0.272
身高(cm)	167.50±7.91	164.50±9.22	t=0.942	0.354
体质量(kg)	67.43±11.23	66.71±11.23	t=0.172	0.864
BMI(kg/m²)	23.91±2.50	24.67±3.63	t=-0.658	0.516
高血压[例(%)]	9(60.0)	8(57.1)		1.000
冠心病[例(%)]	3(20.0)	0		0.224
糖尿病[例(%)]	3(20.0)	2(14.3)		1.000
前次手术位置(上腹)[例(%)]	6(40.0)	6(42.9)		1.000
前次手术入路(腔镜)[例(%)]	12(80.0)	10(71.4)		0.682
粘连程度[例(%)]			U=95.000	0.643
Ⅰ级	5(33.3)	3(21.4)
Ⅱ级	5(33.3)	6(42.9)
Ⅲ级	5(33.3)	5(35.7)

下载: 导出CSV

表 2 两组患者二次手术情况比较

项目	可视组(n=15)	开放组(n=14)	统计值	P值
穿刺套管放置时长(s)	35.00(21.00~46.00)	180.00(152.50~252.50)	U=0	＜0.001
伤口大小(cm)	1.10(1.00~1.20)	2.80(2.45~3.00)	U=0	＜0.001
出血量(mL)	50.00(50.00~150.00)	50.00(50.00~100.00)	U=93.000	0.569
手术时长(min)	155.40±63.30	173.07±62.51	t=-0.756	0.456
住院费用(万元)	3.83±1.18	3.82±0.92	t=0.012	0.990

下载: 导出CSV

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