超重和肥胖患者建立气腹新穿刺点的探讨

A new entry point to establish the pneumoperitoneum for overweight and obesity patients

目的探讨超重和肥胖患者经左腹直肌外缘与肋弓交点(Meng’s点)穿刺建立气腹的安全性和可行性。方法回顾性分析2015年4月至2019年3月在北京中日友好医院普外科采用Meng’s点穿刺建立气腹的40例超重和肥胖患者的临床资料,通过CT影像测定所有患者Meng’s点、Palmer’s点(左锁骨中线肋缘下3cm)和脐周(脐环上缘)的腹壁厚度,记录从开始腹腔给CO2到气腹压达到12mmHg的时间和进气量,观察术中腹壁及腹腔内脏器副损伤情况,记录穿刺成功情况。结果全组Meng’s点、Palmer’s点和脐周的腹壁垂直厚度分别为(3.73±1.26)cm、(3.97±1.36)cm和(4.19±1.73)cm,三者比较差异无显著性(F=0.97,P=0.38)。经Meng’s点建立气腹时气腹针成功穿刺时间为(11.08±1.35)s,从开始腹腔给气到气腹压达到12mmHg的时间为(65.00±8.70)s,进气量为(4.08±0.39)L。全组无明确术中副损伤,建立气腹均一次气腹针穿刺成功。结论对超重和肥胖患者经Meng’s点建立气腹方便快捷、安全可行。

Objective To explore the feasibility and safety of the new entry points to establish the pneumoperitoneum for overweight and obesity patients.Method The clinical data of 40 overweight and obesity cases undergoing pneumoperitoneum used the new entry point(Meng’s point)from April 2015 to March 2019 at the general surgery department of China-Japan friendship hospital were retrospectively analyzed.Measure the vertical thickness of the abdominal wall of Meng’s point(the intersection of the left rectus abdominis external margin and the left rib arch),Palmer’s point(3 cm below the costal margin and in the midclavicular line.)and peripheral umbilical(the upper margin of umbilical).Record the time when puncture was established successfully,from the time when the pneumoperitoneum beginning to the time when the pneumoperitoneum pressure reached 12 mmHg,and the amount of intake CO2.Observed complications during entry in laparoscopy and monitored puncture times.Result The thickness of the abdominal wall of the three groups of puncture points were(3.73±1.26)cm,(3.97±1.36)cm and(4.19±1.73)cm,and there were no significant difference(F=0.97,P=0.38).From the beginning of the pneumoperitoneum to the time when the pneumoperitoneum pressure reached 12 mmHg was(65.00±8.70)s.From the beginning of the pneumoperitoneum to the pneumoperitoneum pressure reached 12 mmHg consumed(4.08±0.39)L CO2.No puncture injury occurred.The whole group established the pneumoperitoneum successfully by puncture one time.Conclusion To establish pneumoperitoneum at Meng’s point was safety and feasibility.