Lam K W, Pun T C
Department of Obstetrics and Gynaecology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.
J Am Assoc Gynecol Laparosc. 2002 May;9(2):199-203. doi: 10.1016/s1074-3804(05)60132-6.
To determine the usefulness of the left upper quadrant approach in gynecologic laparoscopic surgery.
Retrospective study (Canadian Task Force classification II-2).
University referral center.
Twenty-four women with longitudinal scars from previous laparotomy through or close to the umbilicus.
Left upper quadrant was chosen as the site of primary entry of the reusable Veress needle (ninth or tenth left intercostal space) and reusable primary cannula (left upper quadrant just below the left subcostal margin).
Intraabdominal adhesions between old longitudinal scars and underlying bowel or omentum were present in 14 patients. Adhesions involving omentum only were present in 10 patients, bowel only in 2, and both omentum and bowel in 2. The only intraoperative complication was emphysema in one woman. All operative procedures were completed laparoscopically.
The left upper quadrant approach is a safe entry point for reusable instruments at laparoscopic surgery in patients with midline incisions close to the umbilicus.
确定左上腹入路在妇科腹腔镜手术中的实用性。
回顾性研究（加拿大工作组分类II-2）。
大学转诊中心。
24名有既往经脐或靠近脐的剖腹手术纵向瘢痕的女性。
选择左上腹作为可重复使用的韦雷斯针（左第9或第10肋间间隙）和可重复使用的主套管针（左肋缘下稍下方的左上腹）的主要穿刺部位。
14例患者在旧的纵向瘢痕与下方肠管或网膜之间存在腹腔内粘连。仅累及网膜的粘连有10例患者，仅累及肠管的有2例，同时累及网膜和肠管的有2例。唯一的术中并发症是1名女性发生气肿。所有手术操作均通过腹腔镜完成。
对于有靠近脐的中线切口的患者，左上腹入路是腹腔镜手术中可重复使用器械的安全穿刺点。
