气腹造影螺旋CT影像技术在有腹部手术史患者腹腔镜手术中的价值

Pneumoperitoneum Helico-CT Imaging for Laparoscopic Surgery for the Patients with Previous Abdominal Operation

目的探讨气腹造影螺旋CT影像技术(pneumoperitoneum helico-CT imaging,PHCT)在腹部手术后患者再次行腹腔镜手术时安全建立气腹的指导价值。方法 2007年2月～2011年6月我院205例有腹部手术史患者再次行腹腔镜手术前,采用局麻下腹壁穿刺注气,建立人工气腹,经64排螺旋CT扫描,预先判定是否存在腹壁粘连及粘连部位、范围和结构,为腹腔镜手术闭合法入路的安全选点提供技术保障。结果术前PHCT检查21例无腹壁粘连,142例为非脐孔部位的局限性腹壁粘连,42例脐孔周围有局限性腹壁粘连。以脐孔为观察孔(第一戳孔)131例,经腹壁其他部位为第一戳孔74例。全部采用闭合法完成腹腔镜置入,无一例发生与手术入路有关的并发症。结论有腹部术史患者通过PHCT能够明确腹内粘连的情况,为腹腔镜手术时腹壁闭合法入路技术操作的安全性提供保障。

Objective To evaluate pneumoperitoneum helico-CT imaging （PHCT） for laparoscopic surgery in the patients with previous abdominal operation. Methods From February 2007 to June 2011, we performed laparoscopic surgery on totally 205 patients who had history of abdominal operation. Under local anesthesia, we established pneumoperitoneum for 64-detector-row helico- CT scan, so that to explore abdominal adhesion, and its site, extent and structure before carrying out laparoscopic surgery. Results PHCT showed no abdominal adhesion in 21 patients, local non-umbilical adhesion in 142 patients, and local umbilical adhesion in the other 42 patients. With an observation hole at umbilicus （131 cases） or other abdominal site （74 cases）, we completed laparoscopic surgery successfully, without causing any surgical approach-reahed complications. Conclusion PHCT ensures the safety of laparoscopic surgery in patients with history of abdominal operation.