免气腹悬吊技术在腹腔镜手术中的应用

Laparoscopic surgery using gasless lifting method

目的:探讨免气腹悬吊技术在腹腔镜手术中应用的可行性、安全性和优越性。方法:回顾分析2007年6月至2010年12月采用免气腹悬吊技术为49例患者行腹腔镜手术的临床资料,其中结节性甲状腺肿23例,原发性甲状腺功能亢进7例,胆囊结石12例,腹股沟疝7例。应用腹壁悬吊器,用2根骨科克氏针穿过皮下牵拉,悬吊颈前皮瓣或前腹壁形成手术空间完成腹腔镜手术。结果:49例均成功完成手术,无中转开放手术。其中一侧甲状腺次全切除术22例,双侧甲状腺次全切除术8例,胆囊切除术12例,完全腹膜外腹股沟疝修补术7例。手术时间20～125min,平均86min,术中出血<30ml。术后无声音嘶哑、胆漏、切口感染等并发症发生。术后住院5～7d,平均6d。术后随访3～38个月,中位随访时间21个月,无复发病例。结论:应用免气腹悬吊技术行腹腔镜手术避免了CO2气腹的相关并发症,吸引水雾、液体方便,手术空间较气腹稍小,但基本不影响手术的进行,是安全可行的。

Objective：To explore the feasibility,safety and advantage of laparoscopic surgery using gasless lifting method. Methods：The clinical course was analyzed retrospectively from Jun.2007 to Dec.2010 for laparoscopic surgery using gasless lifting method.49 cases were selected in this study,including 23 cases of nodular goiter,7 cases of primary hyperthyroidism,12 cases of gallstone,and 7 cases of inguinal hernia.All cases underwent laparoscopic surgery while the operational space was established by using an abdomen suspending device and 2 pieces of Kirschner pin,which were introduced subcutaneously to suspend and retract the anterior neck or abdomen skin. Results：All the surgeries were completed successfully in 49 cases without conversion to open procedure,including 22 subtotal thyroidectomies in one side,8 subtotal thyroidectomies in two sides,12 cholecystectomies,and 7 totally extraperitoneal hernia repairs.The operation time ranged from 20min to 125min（median was 86min）.Intraoperative blood loss was less than 30ml.There were no postoperative complications including hoarseness,bile leakage and incision infection.The postoperative hospital stay time ranged from 5d to 7d（median was 6d）.The patients were followed up for 3 to 38 months（median was 21 months） postoperatively,during which no recurrence occurred. Conclusions：It is a safe and feasible procedure for laparoscopic surgery using gasless lifting method.By using this method,CO2 insufflation-related complications can be avoided and it is more convenient to suck fog and liquid in operation.Although the operational space established by this method is relatively small,the surgery can be completed without much difficulty.