Azevedo João Luiz Moreira Coutinho, Azevedo Otavio Cansanção, Miyahira Susana Abe, Miguel Gustavo Peixoto Soares, Becker Otávio Monteiro, Hypólito Octávio Henrique Mendes, Machado Afonso Cesar Cabral Guedes, Cardia Wellington, Yamaguchi Gilmara Aguiar, Godinho Lola, Freire Dalmer, Almeida Carlos Eduardo Saldanha, Moreira Camila Hobi, Freire Dalmer Faria
Department of Surgery, Division of Operative Techniques and Experimental Surgery, Federal University of Sao Paulo, São Paulo, Brazil.
Surg Endosc. 2009 Jul;23(7):1428-32. doi: 10.1007/s00464-009-0383-9. Epub 2009 Mar 5.
The aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress needle described in the literature.
Iatrogenic injuries caused by Veress needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. The following words were combined: "Veress" or "insufflation needle" or "pneumoperitoneum needle," and "complications" or "injuries" or "lesions." The bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress needle insertion in the studies that reported Veress needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution).
Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). Of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. Of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed).
The insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.
本研究旨在评估文献中描述的韦雷氏针所致损伤的发生率、风险及后果。
在Medline、Lilacs、Embase、Scielo和Cochrane图书馆数据库中对人类诊断性或治疗性腹腔镜检查期间韦雷氏针插入所致医源性损伤进行研究，无语言限制。将以下词汇组合：“韦雷氏”或“气腹针”或“人工气腹针”，以及“并发症”或“损伤”或“病变”。还对所选文章的参考文献进行了分析。我们考虑了以下几点：（1）文献中描述的损伤数量；（2）在报告韦雷氏针损伤的研究中，损伤数量与接受韦雷氏针插入的患者数量之间的关系；（3）受损的器官和结构（腹膜后血管、消化道以及自限性轻微损伤）；（4）后果（死亡、中转开腹、腹腔镜修复、自行缓解）。
38篇所选文章包括696,502例腹腔镜检查，有1,575例损伤（0.23%），其中126例（8%）涉及血管或中空脏器（占所有腹腔镜检查的0.018%）。在98例血管损伤中，8例（8.1%）为主要腹膜后血管损伤。另有34例报告的腹膜后损伤，但作者未具体说明损伤的是哪条血管。在28例中空脏器损伤中，17例被认为是严重损伤，即60.7%（占评估总病例的0.0024%）。
在脐部腹中线插入韦雷氏针会对患者生命构成严重风险。因此，应开展进一步研究以探究韦雷氏针插入的替代部位。
