重力线原则在腹腔镜结直肠手术中应用价值研究(附504例报告)  

Gravity line strategy in laparoscopic colorectal surgery:A report of 504 cases

作　　者：官文龙[1] 车忠广 朱跃坤[1] 朴大勋[1] 姜洪池[1] 朱安龙[1] 

机构地区：[1]哈尔滨医科大学附属第一医院普外科,黑龙江哈尔滨150001

出　　处：《中国实用外科杂志》2015年第2期183-186,共4页Chinese Journal of Practical Surgery

摘　　要：目的 探讨腹腔镜镜头旋转与腹腔镜乙状结肠和直肠手术中损伤的关系,总结腹腔镜手术的基本操作原则。方法 回顾性分析2006年9月至2014年3月哈尔滨医科大学附属第一医院普外科完成的504例腹腔镜乙状结肠和直肠手术资料。测量腹腔镜镜头旋转角度（〈15°、15-30°和〉30°）,分析术中损伤发生率及镜头旋转角度的关系。结果 无损伤组病人术中镜头旋转角度分布为：〈15°437例,15-30°31例,无旋转角度〉30°者;而损伤组则为：〈15°4例,15-30°25例,〉30°7例,两组差异有统计学意义（χ2=235.57,P〈0.001）。按手术时间顺序对病人进行分组,每100例为1组（最后一组为104例）,后4组病人（均采用重力线原则）术中镜头旋转角度分布差异均无统计学意义（P〉0.05）,且与第一组（前100例,未采用重力线原则）差异均有统计学意义（P〈0.05）。结论 镜头旋转角度过大易增加腹腔镜直肠手术术中损伤的风险;重力线原则可避免镜头旋转,降低手术风险,快速提高手术水平,建议作为腹腔镜手术的基本原则加以遵循。Objective To analyze the correlation between intraoperative complications in the laparoscopic sigmoidocoliand rectal surgery and tilt view, propose a basic operating criterion for the ]aparoscopic procedure. Methods Theclinical data of 504 cases of laparoscopic low anterior resection and abdominoperineal resection performed betweenSeptember 2006 and March 2014 in Department of General Surgery, the First Affiliated Hospital of Harbin MedicalUniversity were analyzed retrospectively. The tilt angles （〈15°, 15 °30°, 〉30° ）were measured. The incidence ofintraoperative complication and tilt angle were calculated and statistical analysis was performed. Results Tilt angles ofcontrols group were at 〈15° in 437 cases, at 15 ° 30° in 31 cases and none was at 〉30°. In complication group, tiltangles of surgical field were at 〈15° in 4 cases, at 15- 30° in 25 cases and at 〉30° in 7 cases. The difference wassignificant statistically between the control group and complication group（X2=235.57, P〈0.001 ）. There was no statisticaldifference in tilt angle among the last 4 groups（ 100 cases in each group in chronological order） （P〉0.05）. The differencewas significant statistically between the 1st group and the last 4 groups （P〈0.05）. Conclusion Excessive tilt view canincrease the risk of laparoscopic colorectal surgery. Gravity line strategy is proposed as one of the basic operating criteriato correct the tilt angle.

关 键 词：腹腔镜手术 并发症 重力线原则 

分 类 号：R6[医药卫生—外科学]