摘要
目的 探讨腹腔粘连患者腹腔镜胆囊切除术 (LC)闭合法建立气腹的方法。方法回顾性分析 1991年 9月～ 1999年 9月 6 6 0 0例LC中 10 46例腹腔粘连患者闭合法建立气腹的经过。建立气腹困难分为真性建立气腹困难及假性建立气腹困难 2种。由于气腹针穿入腹腔脏器或腹腔广泛粘连导致气体弥散困难引起的建立气腹困难称真性建立气腹困难 ,需中转开腹手术 ;由于气腹针位置错误如位于腹膜外脂肪层、肝园韧带或大网膜内引起的建立气腹困难称假性建立气腹困难 ,调整气腹针位置 ,均能满意建立气腹。结果 10 46例中 10 2 8例成功建立气腹。 5例因真性建立气腹困难 ,13例因假性建立气腹困难而中转开腹。本组腹腔粘连患者闭合法建立气腹成功率为 98 3%。结论 腹腔粘连患者闭合法建立气腹是安全可行的。缺乏自信、经验不足、误把假性建立气腹困难当作真性建立气腹困难是腹腔粘连患者闭合法建立气腹失败的主要原因。
Objective To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods CEPP experiences of 1?046 patients in 6?600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO 2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results Of the 1?046 patients, 1?028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.
出处
《中国普通外科杂志》
CAS
CSCD
2001年第1期46-48,共3页
China Journal of General Surgery
关键词
腹腔粘连
胆囊切除术
腹腔镜
气腹
外科手术
PERITONEAL ADHESION/surg
CHOLECYSTECTOMY,CAPAROSCOPY
PNEUMOPERITONEUM ARTIFICIAL
