“一刀一剪”法建立经腹腹腔镜手术观察镜通道有效性及安全性的研究

The effectiveness and safety of"one scalpel and one scissors"method to establish laparoscopic observation access for transperitoneal laparoscopic surgery

目的探讨"一刀一剪"法穿刺建立经腹腹腔镜手术观察镜通道的临床有效性与安全性。方法收集2018年10月至2020年10月中山市人民医院196例经腹腹腔镜上尿路手术患者的病历资料进行回顾性分析,。根据观察镜通道建立方法分为研究组与对照组,其中研究组("一刀一剪"法)97例,对照组(切开法组)99例,比较两组建立观察通道时严重并发症(Clavien-Dindo3级及以上并发症)、轻微并发症(Clavien-Dindo分级1级或2级并发症)发生率及通道建立时间的差异。结果两组建立经腹腹腔镜手术观察镜通道均无严重并发症发生(血管、肠道、肠系膜或实体器官的损伤);研究组通道建立时间明显缩短[(90±19)s vs(193±25)s,P<0.001],气体泄漏率明显减少(2.06%vs 10.10%,P=0.019),皮下气肿发生率降低(1.03%vs 8.08%,P=0.018),切口感染率(2.06%vs 9.09%,P=0.033)及切口疼痛发生率明显降低(3.09%vs 12.12%,P=0.017)。结论"一刀一剪"法建立经腹腹腔镜手术观察镜通道的方法是一种快速、安全、有效的腹腔镜建立通道方法,值得推广应用。

Objective To compare the outcome of"one scalpel and one scissors"in terms of feasibility and complications with a well-established and widely practiced open access technique(OAT)for a laparoscopic procedure.Methods One hundred and ninety-six participants undergoing transabdominal laparoscopic upper urinary tract surgery in Zhongshan People’s Hospital from October 2018 to October 2020 were collected and analyzed retrospectively,including 97 cases of Group A for"one scalpel and one scissors"and 99 cases of Group B for OAT.The primary endpoint was major complications(bowel,major vessel,and solid organ injury having the potential of causing Clavien-Dindo complication of grade 3 and above)and the secondary endpoint was port access time and minor complications(Clavien-Dindo complication of grade 1 or 2 such as access port-site infection and bleed,subcutaneous emphysema,access port-site pain,entry reattempted,and gas leakage)directly related to access.Patients were assessed for feasibility and complications.Results There was no statistical difference in major complications between Group A and Group B,however,Group A was found to be superior to Group B,in terms of port access time[(90±19)s vs(193±25)s,P<0.001],gas leakage(2.06%vs 10.10%,P=0.019),subcutaneous emphysema(1.03%vs 8.08%,P=0.018),access port-site infection(2.06%vs 9.09%,P=0.033),access port-site pain(3.09%vs 12.12%,P=0.017).Conclusion"One scalpel and one Scissors"method to establish laparoscopic observation access for trans peritoneal laparoscopic surgery is a good and safe technique of laparoscopic access.The technique of"one scalpel and one Scissors"is worthy of popularization and application by laparoscopic surgeons.