腹腔镜后腹腔间隙建立失误分析及经验总结  

Error analysis and experience summary in setting up the retroperitoneal cavity for peritoneoscopy

作　　者：崔小健[1] 丛桂成[1] 姚庆祥[1] 李伯全[2] 

机构地区：[1]天津市泰达医院泌尿外科,300450 [2]中国人民解放军第二五四医院泌尿外科

出　　处：《天津医药》2017年第12期1300-1303,共4页Tianjin Medical Journal

摘　　要：目的探讨建立后腹腔间隙过程中存在的失误及其原因。方法收集2009年5月—2016年12月在我科完成的后腹腔镜手术患者450例临床资料,根据穿刺位点分为腰部组(193例)和髂嵴上组(276例)。总结在建立后腹腔间隙过程中出现的失误并分析其原因。结果在后腹腔间隙建立过程中出现了腹膜破裂(10例)、气囊扩张间隙错误(5例)、自制气囊破裂脱落及排气不畅(7例)、穿刺套管位置不佳(34例)、穿刺通道出血(6例)、套管周围漏气、皮下气肿等失误,分别采用了腹膜修补、重新建立扩张间隙、调整套管位置等相应措施进行处理。450例患者手术均顺利完成。结论应根据患者的不同情况选择合适的建腔方式,同时应熟悉腹膜后腔的解剖,注重后腹腔间隙建立过程中各个细节,减小失误的发生。Objective To explore errors and their causes in setting up the retroperitoneal cavity for peritoneoscopy. Methods The clinical data of 450 patients who were performed the laparoscopie surgery in our hospital from May 2009 to December 2016 were collected. According to the trocar puncture points, patients were divided into lumbar group （n= 193） and iliac flap group （n=276）. The problems were summarized and analyzed in the process of setting up the retroperitoneal cavity. Results The mistakes existed in setting up the retroperitoneal cavity including peritoneum rupture （10 cases）, en＇or in balloon expansion clearance （5 cases）, homemade balloon rupture and fall off （7 cases）, poor position of puncture port （34 cases）, b]eeding of puncture channel （6 cases）, leaking around the trocar and subcutaneous emphysema. After peritoneal patching, re-establishment of the expansion of the gap, adjusting the trocar position and other appropriate measures for treatment, the operations were successfully in 450 patients. Conclusion We should choose the appropriate method for building cavity according to different conditions of patients, and know well the anatomy of the peritoneal cavity. All details should be emphasized in the process of building cavity to reduce the occurrence of errors.

关 键 词：腹腔镜检查 后腹腔镜下 腹膜后腔 失误 

分 类 号：R656.5[医药卫生—外科学]