可视套管一步法穿刺建立经腹腹腔镜手术观察镜通道的初步经验

Direct trocar insertion using optical trocar in the establishment of the observational passage during trans-peritoneal laparoscopic operation-our initial experience

目的 探讨应用可视套管一步法穿刺建立经腹腹腔镜手术观察镜通道的临床价值.方法 选取2015年4-12月120例需行经腹腹腔镜手术患者作为研究对象.所有患者随机分为研究组和对照组,每组60例.研究组男34例,女26例;平均年龄（52.0±11.9）岁;平均体重指数（24.9±2.9） kg/m^2.患者取侧卧位并抬高腰桥,在患侧脐上、腹直肌外缘处预定建立观察镜通道的位置,切开皮肤,采用可视套管在腹腔镜直视下一步法穿刺进入腹腔,置入腹腔镜确认套管进入腹腔后,继续进行后续操作.对照组男36例,女24例;平均年龄（52.9±11.4）岁;平均体重指数（25.2 ±2.4） kg/m^2.患者采用传统逐层切开入腹建立通道的方法.比较两组建立通道的时间、通道漏气率、通道出血率、腹腔镜手术脏器损伤发生率的差异.结果 研究组与对照组相比,通道建立平均时间明显缩短（2.7min vs.15.9 min,P＜0.05）,通道漏气率明显减少（0 vs.30％,P＜0.05）.两组均未发生通道出血和腹腔脏器损伤.结论 可视套管一步法穿刺建立经腹腹腔镜手术观察镜通道的方法高效、安全,值得在临床实践中继续探索.

Objective To evaluate the clinical significance of direct trocar insertion using optical trocar in the establishment of the primary port during trans-peritoneal laparoscopic surgical procedures.Methods A prospective study was conducted by collecting the data of 120 patients who should be performed abdominal laparoscopic surgery from April 2015 to December 2015.The 120 patients were randomly divided into a research group and a control group.The research group consisted of 34 male patients and 26 female patients,mean age was （52.0 ± 11.9） years and mean BMI was （24.9 ± 2.9） kg/m^2.In research group,patients were positioned laterally with the flank padded and elevated.A predetermined position was drawn prior to surgery between the umbilicus and lateral rectus abdominis,for the creation of the primary laparoscopic trocar port.The predetermined point was incised,and then the method of direct trocar insertion using the optical access trocar was used for establishment of the primary port.After this maneuver was completed the surgery continued as indicated.The control group consisted of 36 male patients and 24 female patients,whose mean age was （52.9 ± 11.4） years and mean BMI was （25.2 ± 2.4） kg/m^2.This group underwent the traditional method of port construction by incision into the abdomen.The time of constructing the passage,leakage rate,bleeding rate,and injury rate of abdominal organs were compared.Results In research group,the time of building primary port was clearly shorter than that in control group （2.7min vs.15.9min,P 〈 0.05）,the leakage rate was also obviously reduced compared to that in control group （0 vs.30%,P 〈 0.05）.Neither groups observed any significant bleeding nor visceral organ damage throughout the study.Conclusion Direct trocar insertion using optical trocar to establish observation port is a highly efficient and safe method in trans-peritoneal laparoscopic operation,which should be research thoroughly in clinical practice.