后腹腔镜手术中不同腹膜后腔建立方法的效果比较

Comparison in clinical efficacy of different techniques in setting up the retroperitoneal cavity in retroperitoneoscopy

目的比较手指扩张法、单气囊扩张法和双气囊扩张法在后腹腔镜手术中建立腹膜后腔的效果及安全性。方法回顾性分析自2014年3月至2015年3月共计320例后腹腔镜手术患者的临床资料,其中41例行手指扩张法、80例单气囊扩张法、199例双气囊扩张法建立腹膜后腔。比较各组患者的体重指数、建立后腹腔时间及建立后腹腔阶段的并发症。结果手指扩张组患者体重指数明显低于气囊扩张组患者,差异具有统计学意义(P<0.001)。手指扩张组建立初始后腹腔及整理后腹腔所用时间均显著少于气囊扩张组(P<0.001);但手指扩张组腹膜损伤发生率显著高于气囊扩张组(P<0.05)。单气囊扩张组与双气囊组比较,在整理后腹腔阶段,双气囊扩张组明显快于单气囊扩张组(P<0.001),且气囊破裂发生率方面双气囊组明显少于单气囊组(P<0.05)。结论对于低体重指数患者,手指扩张法在建立腹膜后腔中用时最少,最快捷,但有腹膜损伤的风险,须仔细操作。在气囊扩张法中,双气囊扩张较单一气囊扩张有效地减少了气囊破裂的发生率,可以建立满意的初始后腹腔空间,在整理后腹腔阶段更省时、快捷。

Objective To compare the efficacy of different techniques in setting up the retroperitoneal cavity in retroperitoneoscopy.Methods Clinical data of 320 patients treated with retroperitoneoscopy during Mar.2014 and Mar.2015 were retrospectively reviewed.The retroperitoneal cavity was established in various ways,including finger dilatation in 41 cases,single balloon dilatation in 80 cases and double balloon dilatation in 199 cases.The body mass index（BMI）of patients,time used to establish the cavity,and related complications were compared.Results The BMI was higher in the balloon dilatation group than that in the finger dilatation group[（25.8±2.7）vs.（17.6±2.3）kg/m2,P0.001].The mean time used to establish cavity was shorter in finger dilatation group than that in the balloon dilatation group[（3.6±0.8）vs.（7.2±1.3）min,P0.001],while the peritoneum injury rate was higher（P0.05）.The mean time used to arrange the cavity was shorter in double balloon dilatation group than that in single balloon dilatation group[（4.5±1.1）vs.（7.4±1.6）min,P0.001],and the balloon burst rate was lower（P0.05）.Conclusion The finger dilatation technique is a simple method to establish the retroperitoneal cavity in low BMI patients,but we should be careful to avoid peritoneum injury when putting trocar near the anterior axillary line.The double balloon dilatation technique is effective for arranging the retroperitoneal cavity,with lower balloon burst rate than single balloon dilatation.