直视一步法建立观察镜通道在经腹腹腔镜肾上腺切除术中的应用

Application of one-step trocar insertion visibility for observation port establishment in transperitoneal laparoscopic adrenalectomy

目的探讨直视一步法建立观察镜通道在经腹途径腹腔镜肾上腺切除术中的应用。方法回顾性分析2015年4月至2017年12月间26例经腹途径腹腔镜肾上腺切除术的病例资料。根据曲卡置入方法分为两组:观察组13例,均采用可视套管在腹腔镜直视下一步法穿刺进入腹腔建立腹腔镜手术通道;对照组13例,采用常规的开放切开法(Hasson法)建立腹腔镜手术操作通道,后续的肾上腺切除方法相同。观察指标包括曲卡置入时间、肾上腺切除时间、手术总时间、术中出血量、术后禁食时间、术后引流管留置时间及术后住院时间等。比较分析直视一步法与常规开放法建立观察镜通道的时间及其对手术结果指标的影响。结果两组手术均成功施行,无一例中转开放手术。观察组的曲卡置入时间、手术总时间明显少于对照组,而肾上腺切除时间、术中出血量、术后禁食时间、引流管留置时间及术后住院天数等差异均无统计学意义。结论直视一步法建立观察镜通道在经腹途径腹腔镜肾上腺切除术中安全、有效,可明显减少曲卡置入时间及总体手术时间,提高手术安全性。

Objective To explore the application of one-step trocar insertion visibility for observation port establishment in transperitoneal laparoscopic adrenalectomy. Methods A retrospective analysis was conducted by collecting the data of 26 patients who had been performed transperitoneal laparoscopic adrenalectomy from April 2015 to December 2017. One-step trocar insertion visibility were performed for the observation group（13 cases）, while conventional open incision（Hasson） method was used for the control group（13 cases）. The same process was performed in subsequent adrenalectomy. The time of trocar insertion, operation time（removal of adrenal gland）, total operation time, blood loss, postoperative fasting time, post-operative drainage time, and the hospitalization time after operation between two groups were compared. Results Operations were successfully performed in all cases, and no patient was converted to open surgery. The time of trocar insertion and total operation process in observation group were less than control group. However, between two groups, there were no significant differences in time of removal of adrenal gland, blood loss, post-operative fasting time, drainage and the hospitalization time after operation. Conclusions One-step trocar insertion visibility to establish observation port in transperitoneal laparoscopic adrenalectomy is safe and effective which can reduce the time of trocar insertion and total operation process, improve the safety of the operation as well.