可视穿刺套管在腹部术后再次行腹腔镜肝脏手术中的应用

Application of optical trocar insertion in laparoscopic surgery after previous abdominal surgery

目的探究可视穿刺套管建立气腹在腹部术后再次腹腔镜手术中的应用价值。方法纳入北京协和医院2017年5月—2019年5月既往有腹部手术史的拟行腹腔镜肝脏手术的患者共29例,随机分为可视穿刺套管建立气腹组及开放方式建立气腹组。符合正态分布的计量资料组间比较采用独立样本t检验;非正态分布的计量资料组间比较采用Mann-Whitney U检验;计数资料组间比较采用Fisher精确检验,等级资料组间比较采用Mann-Whitney U检验。结果两组均没有相关并发症的发生。可视组需要穿刺时间较开放组明显缩短[35.00(21.00~46.00)s vs 180.00(152.50~252.50)s,U=0,P<0.001]。可视组观察孔切口大小明显小于开放组[1.10(1.00~1.20)cm vs 2.80(2.45~3.00)cm,U=0,P<0.001]。结论对既往有腹部手术史的患者再次行腹腔镜肝脏手术,采用可视穿刺套管建立气腹或开放方式建立气腹都是相对安全的,但可视穿刺套管方式建立气腹更高效且微创。

Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery.Methods A total of 29 patients,with a history of abdominal surgery,who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group.The independent samples t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the Fisher’s exact test was used for comparison of categorical data between groups;the Mann-Whitney U test was used for comparison of ranked data between groups.Results There were no procedure-related complications in either group.Compared with the open approach group,the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum[35.00(21.00-46.00)seconds vs 180.00(152.50-252.50)seconds,U=0,P<0.001]and a significantly smaller incision length[1.10(1.00-1.20)cm vs 2.80(2.45-3.00)cm,U=0,P<0.001].Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery,while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.