泌尿外科腹腔镜手术套管穿刺并发症的预防(附802例报告)

Prevention of complications in urological laparoscopic port insertion

目的:探讨泌尿外科腹腔镜手术采用直接切开法置入套管预防穿刺相关并发症。方法:泌尿外科腹腔镜手术802例,153例经腹腔入路,649例经后腹腔入路。经腹腔途径第一套管穿刺部位一般选择在脐周或腹直肌外侧缘平脐处。切开皮肤1.5cm,依层次切开腹膜,套管鞘直接插入切开的腹腔内。经后腹腔途径第一套管穿刺部位选择在腋中线髂棘上2cm处,切开皮肤1.5cm,钝性分开各层,示指进入扩张后腹腔,套管鞘直接插入后腹腔。其余套管均在直视下穿刺。结果:802例手术套管置入全部成功,无一例重要脏器及大血管损伤,手术视野良好,无一例患者因套管置入引起并发症而导致中转开放手术。802例直接切开置入第一套管处无一例出现切口出血,第二、第三、第四、第五套管采用穿刺置管,共发生腹壁或腰部穿刺点出血5例,经电灼止血后出血停止。结论:泌尿外科腹腔镜手术采用直接切开法置管安全可靠。

Objective：To prevent complications associated with urological laparoscopic port insertion using open Hasson technique. Methods： A total of 802 patients underwent urological laparoscopic procedures. There were 153 transperitoneal and 649 retroperitoneal laparoscopic procedures. A 15 mm to 20 mm skin incision was made near the umbilicus or under the 12th rib, followed by sharp and blunt dissection to visualize the external fascia. The fascia is incised and muscle layers were split, revealing the transversalis fascia and peritoneum, which was open sharply. The Hasson blunt tip cannula was then inserted ans secured. Retroperitoneal access also typically used this technique. The retroperitoneum was entered digitally by blunt dissection. A 10 mm. trocar was inserted. After pneumoperitoneum was established, 2 4 additional trocars were placed under endoscopic vision. Results：All laparosopic access was successfully performed, there were no major vascular injuries and major visceral injuries. No conversion to open surgery due to complication with trocar insertion. There were only 5 patients with port site bleeding controlled by cautery. Conclusions：Open Hasson technique is safe in urological laparoscopy.