Agarwala Neena, Liu C Y
University of Nebraska Medical Center, Omaha, Nebraska 68198-3255, USA.
J Minim Invasive Gynecol. 2005 Jan-Feb;12(1):55-61. doi: 10.1016/j.jmig.2004.12.026.
Surgeons performing sophisticated endoscopic operations must be well versed in alternate laparoscopic access methods to address evolving patient expectations and safety requirements. The safety of left upper quadrant laparoscopic entry in patients with prior surgeries and abdominal adhesions was evaluated. Laparoscopic surgery was performed for various indications on patients with prior surgical scars and anticipated risk of adhesions at the primary umbilical port site. All laparoscopies performed from July 1998 through June 2004 were analyzed. Of the 918 laparoscopies, 504 patients (54.9%) were found to have involvement of their umbilicus with adhesions that could have affected the traditional umbilical primary port entry. Left ninth intercostal space was used for Veres needle entry, and the primary trocar was placed in the left upper quadrant space. Of the 504 potentially risky entries, there were two (0.39%) Veres-needle related and zero trocar-related injuries. All surgical procedures were accomplished laparoscopically, and all entries were accomplished by the left upper quadrant entry technique. Therefore left upper quadrant entry technique is a safe and easily learned alternate access technique.
进行复杂内镜手术的外科医生必须精通多种腹腔镜进入方法，以满足患者不断变化的期望和安全需求。我们评估了既往有手术史且存在腹部粘连的患者左上腹腹腔镜进入的安全性。对有既往手术瘢痕且预计在原脐部端口部位存在粘连风险的患者，因各种适应证进行了腹腔镜手术。分析了1998年7月至2004年6月期间进行的所有腹腔镜手术。在918例腹腔镜手术中，发现504例患者（54.9%）脐部存在粘连，这可能会影响传统的脐部主端口进入。使用左第九肋间间隙进行Veres针穿刺，主套管针置于左上腹间隙。在504例潜在风险穿刺中，有2例（0.39%）与Veres针相关，与套管针相关的损伤为零。所有手术均通过腹腔镜完成，所有穿刺均采用左上腹穿刺技术。因此，左上腹穿刺技术是一种安全且易于学习的替代进入技术。
