“一刀一剪”法建立经腹腹腔镜手术观察镜通道有效性及安全性的研究  

The effectiveness and safety of"one scalpel and one scissors"method to establish laparoscopic observation access for transperitoneal laparoscopic surgery

作　　者：卢扬柏[1] 黎卫[1] 张泳欣 黄亚强[1] 曹彬[1] 罗刚[1] 袁润强[1] 黄红星[1] Lu Yangbai;Li Wei;Zhang Yongxin;Huang Yaqiang;Cao Bin;Luo Gang;Yuan Runqiang;Huang Hongxing(Department of Urology Zhongshan City People's Hospital Affiliated to Sun Yat‑sen University,Zhongshan 528403,China;Department of MR,Zhongshan City People's Hospital Affiliated to Sun Yat‑sen University,Zhongshan 528403,China)

机构地区：[1]中山市人民医院泌尿外科,广东528403 [2]中山市人民医院MR室,广东528403

出　　处：《中华腔镜泌尿外科杂志（电子版）》2021年第3期192-197,共6页Chinese Journal of Endourology(Electronic Edition)

基　　金：2019年中山市人民医院科研基金课题(B2019046);2019年中山市医学科研项目(2019J042);2019年中山市科技计划项目(2019B1063);2020年中山市科技计划项目(2019B1073)。

摘　　要：目的探讨"一刀一剪"法穿刺建立经腹腹腔镜手术观察镜通道的临床有效性与安全性。方法收集2018年10月至2020年10月中山市人民医院196例经腹腹腔镜上尿路手术患者的病历资料进行回顾性分析,。根据观察镜通道建立方法分为研究组与对照组,其中研究组("一刀一剪"法)97例,对照组(切开法组)99例,比较两组建立观察通道时严重并发症(Clavien-Dindo3级及以上并发症)、轻微并发症(Clavien-Dindo分级1级或2级并发症)发生率及通道建立时间的差异。结果两组建立经腹腹腔镜手术观察镜通道均无严重并发症发生(血管、肠道、肠系膜或实体器官的损伤);研究组通道建立时间明显缩短[(90±19)s vs(193±25)s,P<0.001],气体泄漏率明显减少(2.06%vs 10.10%,P=0.019),皮下气肿发生率降低(1.03%vs 8.08%,P=0.018),切口感染率(2.06%vs 9.09%,P=0.033)及切口疼痛发生率明显降低(3.09%vs 12.12%,P=0.017)。结论"一刀一剪"法建立经腹腹腔镜手术观察镜通道的方法是一种快速、安全、有效的腹腔镜建立通道方法,值得推广应用。Objective To compare the outcome of"one scalpel and one scissors"in terms of feasibility and complications with a well-established and widely practiced open access technique(OAT)for a laparoscopic procedure.Methods One hundred and ninety-six participants undergoing transabdominal laparoscopic upper urinary tract surgery in Zhongshan People’s Hospital from October 2018 to October 2020 were collected and analyzed retrospectively,including 97 cases of Group A for"one scalpel and one scissors"and 99 cases of Group B for OAT.The primary endpoint was major complications(bowel,major vessel,and solid organ injury having the potential of causing Clavien-Dindo complication of grade 3 and above)and the secondary endpoint was port access time and minor complications(Clavien-Dindo complication of grade 1 or 2 such as access port-site infection and bleed,subcutaneous emphysema,access port-site pain,entry reattempted,and gas leakage)directly related to access.Patients were assessed for feasibility and complications.Results There was no statistical difference in major complications between Group A and Group B,however,Group A was found to be superior to Group B,in terms of port access time[(90±19)s vs(193±25)s,P<0.001],gas leakage(2.06%vs 10.10%,P=0.019),subcutaneous emphysema(1.03%vs 8.08%,P=0.018),access port-site infection(2.06%vs 9.09%,P=0.033),access port-site pain(3.09%vs 12.12%,P=0.017).Conclusion"One scalpel and one Scissors"method to establish laparoscopic observation access for trans peritoneal laparoscopic surgery is a good and safe technique of laparoscopic access.The technique of"one scalpel and one Scissors"is worthy of popularization and application by laparoscopic surgeons.

关 键 词：腹腔镜 操作通道 “一刀一剪”法 开放法 气腹 并发症 

分 类 号：R656[医药卫生—外科学]