腹腔镜胆囊切除术中直接套管针穿刺与Veress针穿刺的比较
Direct trocar insertion versus Veress needle insertion in laparoscopic cholecystectomy.
作者信息
Yerdel M A, Karayalcin K, Koyuncu A, Akin B, Koksoy C, Turkcapar A G, Erverdi N, Alaçayir I, Bumin C, Aras N
机构信息
Department of General Surgery, Ankara University Medical School, Turkey.
出版信息
Am J Surg. 1999 Mar;177(3):247-9. doi: 10.1016/s0002-9610(99)00020-3.
BACKGROUND
Direct insertion of the trocar is an alternative method to Veress needle insertion for the creation of pneumoperitoneum. The safety of direct disposable shielded trocar insertion for the creation of pneumoperitoneum was assessed by comparing with Veress needle insertion during laparoscopic cholecystectomy (LC).
METHODS
One thousand five hundred patients undergoing LC with pneumoperitoneum were included in this study. In 470 patients the Veress needle insertion technique was used, and in 1,030 patients direct trocar insertion technique was used. Patients having indications for open trocar insertion were excluded from the study.
RESULTS
Complication rate was significantly higher in the Veress needle group (14% versus 0.9%; P <0.01), and the two major complications, gastric perforation and iliac artery laceration, were also encountered in this group.
CONCLUSIONS
Our results suggest that with a lower complication rate, direct insertion of the disposable trocar is a safe alternative to Veress needle insertion technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost/instrumentation and rapid creation of pneumoperitoneum.
背景
穿刺套管针直接插入是用于建立气腹的一种替代韦氏针插入的方法。在腹腔镜胆囊切除术（LC）期间，通过与韦氏针插入法进行比较，评估了用于建立气腹的一次性带护套穿刺套管针直接插入的安全性。
方法
本研究纳入了1500例行气腹LC的患者。470例患者采用韦氏针插入技术，1030例患者采用穿刺套管针直接插入技术。有开放穿刺套管针插入指征的患者被排除在研究之外。
结果
韦氏针组的并发症发生率显著更高（14%对0.9%；P<0.01），该组还出现了两种主要并发症，即胃穿孔和髂动脉撕裂。
结论
我们的结果表明，用于建立气腹时，一次性穿刺套管针直接插入法并发症发生率较低，是韦氏针插入技术的一种安全替代方法。这种方法还有诸如成本/器械使用更少以及气腹建立迅速等进一步的优点。
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