免气腹腹腔镜在妇产科手术中的应用体会

The applied experience of gasless laparoscopy for gynecologic surgical procedures

目的:探讨免气腹腹腔镜用于妇科手术的安全性及可行性。方法:用骨科Kirschner Wire针(克氏针)在脐下2cm沿腹白线向下自耻骨联合上4cm穿出,或下腹部横穿皮下(间径约10cm),克氏针两端固定后用吊链挂在悬吊棒横杆上,形成腹腔镜手术空间代替CO2气腹。观察手术时间、术中出血量、术中副损伤、术后并发症及术后患者康复情况等。结果:6例子宫肌瘤切除术,7例子宫附件切除术,10例卵巢囊肿剥除术,5例输卵管切除术,均用免气腹腹腔镜顺利完成,无中转开腹;平均手术时间(75±30)min,平均出血(135±43)ml,平均住院(3.00±0.75)d,无明显并发症发生。结论:免气腹腹腔镜比有气腹腹腔镜更加安全,免除了CO气腹引起的副作用。在直视下施术可用普通器械,手术更加方便。

Objective：To explore the safety and feasibility of the gasless laparoscopy for gynecologic surgical procedures. Methods ： The kirsehner wire punctured the skin at the point of 2cm below the umbilicus, went through linea alba and penetrated out of skin about 4cm above pubic symphysis or traversed the skin of lower abdomen （ the diameter was about as long as 10cm）. After the kirschner wire was fixed with both ends hang by the sling chain on the suspension cross rod, the laparoscopic surgery space was formed to replace the CO2 pneumoperitoneum. The operative time, blood loss, the vice-damage in the operation, the complication and recovery after operation were observed. Results：The gasless laparoscopic surgery was performed as follows：myomectomy in 6 cases, adnexa uteri resection in 7 cases, oophorocystectomy in 10 cases, salpingotomy in 5 cases. No cases were converted to open operation. The average time of operation was （75 ± 30 ）min. The average blood loss was （135 ± 43 ）ml. The average postoperative hospitalization was （3.00 ± 0.75 ）d. No obvious complications occurred. Conclusions： Gasless laparoscopic surgery is safer than the pneumoperitoneum surgery. The side effects which CO2 pneumoperitoneum brings are avoided. The operation are carried on under direct vision, with the available ordinary instruments,the operation is more convenient.