Durand-Réville M, Guichard-Checchi C, Ejnès L, Boulanger J-P, Gilly V, Bongain A, Gillet J-Y
CHU de Nice, Centre Femme-Mère-Enfant, Hôpital Archet II, 151, route de Saint-Antoine de Ginestière, BP 3079, 06202 Nice 3.
J Gynecol Obstet Biol Reprod (Paris). 2003 Nov;32(7):625-33.
To identify and discuss the advantages of the different methods of entry into the peritoneal cavity during gynecological laparascopy in patients who have previously undergone abdominal surgical procedures. Literature review comparing the strengths of each method of entering the peritoneal cavity during gynecological laparoscopic procedures. Adhesions increase the risks of access into peritoneal cavity during laparoscopy. Many techniques or safety rules have recently been described or re-evaluated as an alternative to using the traditional combination "Veress needle and blind introduction of the first trocar". The most relevant were the "open laparoscopy", the use of optical trocar, the double laparoscopy and the use of microlaparoscope. There remains no clear conclusion regarding the optimal form of laparoscopic entry in high risk patients. Relevant data emphasizes that critical to the surgeon's choice of technique is the immediate ability to recognize accidental injury and the capacity to avoid the scarred area. According to the literature review on the procedures used for entering the peritoneal cavity in high risk patients, we conclude that double laparoscopy may indeed be an underused procedure in such cases.
识别并讨论既往接受过腹部外科手术的患者在妇科腹腔镜检查时不同进入腹腔方法的优势。文献综述比较了妇科腹腔镜手术中每种进入腹腔方法的优势。粘连会增加腹腔镜检查时进入腹腔的风险。最近已经描述或重新评估了许多技术或安全规则，以替代使用传统的“韦雷氏针和第一套管针盲目插入”组合。最相关的是“开放腹腔镜检查”、光学套管针的使用、双腹腔镜检查和微型腹腔镜的使用。对于高风险患者腹腔镜进入的最佳形式尚无明确结论。相关数据强调，外科医生选择技术的关键在于立即识别意外损伤的能力以及避开瘢痕区域的能力。根据对高风险患者进入腹腔所用手术方法的文献综述，我们得出结论，在这种情况下，双腹腔镜检查可能确实是一种未充分利用的手术方法。
