腹部腹腔镜手术空间建立方法的进展  

Advances of operation field establishing methods for abdominal laparoscopic surgery

作　　者：张凯[1] 徐安安[1] 胡海[1] 

机构地区：[1]同济大学附属东方医院肝胆胰外科,上海200120

出　　处：《中华腔镜外科杂志（电子版）》2016年第3期183-186,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：上海市卫生局重点课题(20114017)

摘　　要：二氧化碳气腹是目前腹部腹腔镜手术中最主要的术野建立方式,但会对患者术中的心肺功能、血流动力学、肾功能等方面产生不良影响,术后可能导致静脉血栓、肩疼痛、气体栓塞等并发症,甚至可使游离肿瘤细胞在腹腔内播散,而改变媒介气体(如N_2O、氦气等)只能减少一小部分并发症,并且不适用于因心肺功能差无法耐受气腹手术的患者。因此,提升腹壁术野建立方法应运而生,使不能耐受气腹手术的患者获得了微创治疗的机会,还可以避免气体填充所致的并发症。但现有提升式腹部空间建立方法都存在手术空间显露不足的缺陷。笔者对国内外现有腹部腹腔镜手术空间建立方法进行综述,提出以"填充式"和"提升式"对腹部腹腔镜手术空间建立方法进行分类,并对腹部腹腔镜技术手术空间建立方法作出展望。Nowdays CO2 pneumoperitoneum is the main way to establish operation field in abdominal laparoscopic surgery, but it may have side effects on patients of their cardiopulmonary function, hemodynamics and kidney function during the surgery, and may cause postoperative venous thrombosis, shoulder pain, gas embolism, etc, even the spread of tumor cells inside of abdomen. Changing the medium gas such as N20, Helium, etc, can only reduce a few complications of above mentioned, and it does not apply to pa-tients who cannot tolerate pneumoperitoneum surgery because of poor cardiopulmonary function. Therefore, methods that establish operation field by lifting abdominal wall emerge and avoid complications caused by gas filling which make the surgery for those patients who cannot tolerate pneumoperitoneum possible. However, the existing methods have defects of insufficient exposure of operation field. This paper reviewed and summa-rized the existing field establishing methods for abdominal laparoscopic surgery of domestic and international, proposed to classify the operation field establishing methods for abdominal laparoscopic surgery by 4 filling method ’ and 4 lifting method,, and made expectation about the development and perfection of existing opera-tion field establishing methods for abdominal laparoscopic surgery.

关 键 词：气腹 腹腔镜 腹部 

分 类 号：R656[医药卫生—外科学]