下腹部手术史免气腹套管针直接穿刺法可行性探讨

The feasibility of direct insertion without previous pneumoperitoneum after prior abdominal surgery

目的探讨下腹部手术史患者行免气腹脐部直接穿刺置入第一套管针的安全性及可行性。方法统计202例下腹部手术史患者的穿刺成功率,穿刺时间及腹腔内粘连情况及穿刺并发症。随机选取同期无手术史患者210例作为对照组。结果下腹部手术史患者腹腔内粘连发生率37.1%,无1例脐孔粘连,穿刺最短时间为30s,最长为6min,平均时间为(1.01±0.92)min,未发生穿刺并发症。对照组穿刺最短时间20s,最长8min,平均时间为(1.08±0.56)min,两组比较无统计学差异,对照组发生1例大网膜损伤。结论只要充分了解前次手术情况,免气腹脐部直接穿刺置入第一套管针的方法对于有过下腹部手术史的患者仍然安全可靠。

【Objective】To evaluate the safety and feasibility of the first direct trocar insertion without previous pneumoperitoneum to the patient which had previous abdominal operations.【Methods】412 cases with laparoscopic surgery were investigated,202 cases had previous abdominal operations and 210 cases were the first time to have surgery.The trocar related injurys and the adhesion in the body were calculated.【Results】75 in 202 cases（37.1%） had peritoneal adhesions,the insertion time is（1.01 ± 0.92） min.there was no complication in these cases.For the control group the insertion time is（1.08 ± 0.56） min,（P0.05）,Only one patient had a omentum injury.【Conclusions】 The first direct trocar insertion technique provides safe entry into the peritoneal cavity in patients which had previous abdominal operations.