非气腹装置的研制与非气腹腹腔镜手术的临床应用研究

A Study on the Development of Gasless Laparoscopic Devices and Its Clinical Application of Gasless Laparoscopic Surgery.

目的探索14年来自行研制的非气腹装置应用于非气腹腹腔镜手术的安全可行性。方法1993年8月开始不断研制出五代八型非气腹装置,从动物实验逐步应用于临床,实施了15种、90例非气腹腹腔镜手术。结果90例非气腹腹腔镜手术中,7例中转开腹(中转率7.8%),83例包括胆囊切除、结直肠切除、盲肠部分切除、胃大部切除、腹股沟疝修补、腹壁紧缩成形术、肾癌或肾盂癌根治术、巨大食管裂孔疝修补胃底折叠术、子宫切除术等获得成功。结论非气腹腹腔镜手术不仅安全可行,而且充分体现了现代腹腔镜外科技术与传统外科技术的优势互补。它对因气腹禁忌而失去常规腹腔镜手术机会的患者具有重要的补充价值,对某些本需在腹壁造口或需扩大切口取标本的腹腔镜胃肠手术、以及手助肝胆胰手术具有独特而重要的应用价值。

Objective To research the clinical safety and feasibility of homemade gasless laparoscopic devices during the past 14 years.Methods Eight types and five generations of gasless laparoscopic devices（including Semi-tube Retractor,Umbrella Tent,and＂Artificial Ribs＂ⅠⅡⅢ） have been designed and manufactured by the author and his colleagues independently since August 1993.From April 1994 to October 2007,15 sorts and 90 cases of gasless laparoscopic operation have been applied in the clinic after an experimental research.Results Except 7 cases were converted to open surgery （conversion rate 7.8%）,the other 83 cases of gasless laparoscopic cholecystectomy（52）,inguinal herniorrhaphy（2）,abdominoperineal resection of rectal carcinoma（9）,sigmoidectomy（3）,left hemicolectomy（1）,partial excision of cecum（1）,subtotal gastrectomy（1）,abdominal plasty（1）,haital herniorrhaphy with Toupet＇s fundoplication（1）,hysterectomy（1）,and hand assisted gasless laparoscopic sigmoidoproctectomy（1）,right hemicolectomy（1）,nephroureterectomy（9） were successfully performed with no mobidity and mortality.Conclusions Our homemade gasless laparoscopic devices could be applied safely and effectively in the clinic.Gasless laparoscopic surgery has been reflecting the complementary advantages of modern laparoscopic surgery and traditional open surgery.It has the supplementary value in the stage of totally laparoscopic surgery,distinctive value in the stage of laparoscopic-assisted surgery,and very important value in the stage of handassisted laparoscopic surgery.