气腹创建过程中的轻重伤。一项针对12919例病例的多中心研究。

Major and minor injuries during the creation of pneumoperitoneum. A multicenter study on 12,919 cases.

作者信息

Catarci M, Carlini M, Gentileschi P, Santoro E

机构信息

Lap Group Roma, Gruppo Laparoscopico Romano, Via A. Borelli, 5, 00161 Rome, Italy.

出版信息

Surg Endosc. 2001 Jun;15(6):566-9. doi: 10.1007/s004640000381. Epub 2001 Apr 3.

DOI:10.1007/s004640000381

PMID:11591941

Abstract

BACKGROUND

Lap Group Roma was established in 1999 to promote and control the development of laparoscopic surgery in the area of Rome and its province. Complications during the creation of pneumoperitoneum were given a high priority of investigation, and a retrospective enquiry was immediately carried out.

METHODS

A questionnaire about all laparoscopic surgical practice performed from January 1994 to December 1998 was sent to the supervisors of 28 centers of general surgery in the area of Rome and its province participating to the Lap Group Roma, requesting demographics, type of procedure for the creation of pneumoperitoneum, type and timing of operation, and major vascular, visceral, and minor vascular injuries related to the creation of pneumoperitoneum.

RESULTS

The questionnaire was returned by 57% of the centers, for a total of 12,919 laparoscopic procedures. The type of procedure used to create the pneumoperitoneum involved a standard closed approach (Veress needle + first trocar) in 82% of the cases, an open (Hasson) approach in 9% of the cases, and the use of an optical trocar in 9% of the cases. There were seven major vascular injuries (0.05%), eight visceral lesions (0.06%), and nine minor vascular lesions (0.07%), for an overall morbility of 0.18%. There was no death related to these complications. The rate of complications differed significantly (p < 0.0001) depending on the type of approach used. It was 0.27% with the optical trocar (3 of 1,009 cases), 0.18% with the closed approach (20 of 10,664 cases), and 0.09% with the open approach (1 of 1,135 cases).

CONCLUSIONS

There is no foolproof technique for the creation of pneumoperitoneum, and this inquiry confirms the need of a constant search for prevention and early treatment of complications encountered during this obligatory phase of any laparoscopic approach. A well-conducted and prolonged prospective audit of clinical practice could help in identifying the risk factors that can make an alternative approach (open or video controlled) preferable to the widely used closed approach.

摘要

背景

罗马腹腔镜手术小组于1999年成立，旨在促进和控制罗马及其省份地区腹腔镜手术的发展。气腹建立过程中的并发症被列为重点调查对象，并立即开展了一项回顾性调查。

方法

向参与罗马腹腔镜手术小组的罗马及其省份地区28个普通外科中心的负责人发送了一份关于1994年1月至1998年12月期间所有腹腔镜手术操作的问卷，询问人口统计学信息、气腹建立的手术方式、手术类型和时间，以及与气腹建立相关的主要血管、内脏和小血管损伤情况。

结果

57%的中心回复了问卷，共计12919例腹腔镜手术。气腹建立所采用的手术方式中，82%的病例采用标准闭合入路（韦雷氏针+第一套管针），9%的病例采用开放（哈森）入路，9%的病例使用光学套管针。发生了7例主要血管损伤（0.05%）、8例内脏损伤（0.06%）和9例小血管损伤（0.07%），总发病率为0.18%。这些并发症无相关死亡病例。并发症发生率因所采用的入路类型不同而有显著差异（p<0.0001）。光学套管针入路的发生率为0.27%（1009例中有3例），闭合入路为0.18%（10664例中有20例），开放入路为0.09%（1135例中有1例）。