Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, United Kingdom.
Fertil Steril. 2010 Dec;94(7):2716-9. doi: 10.1016/j.fertnstert.2010.03.055. Epub 2010 May 10.
To report our experience using Palmer's point entry in women undergoing gynecologic laparoscopic surgery.
Retrospective observational study.
University teaching hospital, London, United Kingdom.
PATIENT(S): We reviewed all patients who underwent laparoscopic gynecologic surgery under the care of the senior author between January 1, 2005, and December 31, 2008.
INTERVENTION(S): Gynecologic laparoscopic surgery.
MAIN OUTCOME MEASURE(S): Indications, incidence, success, and complications of using Palmer's entry.
RESULT(S): Three hundred eighty-five patients underwent laparoscopic surgery. We used umbilical entry in 249 (64.6%) and Palmer's entry in 136 (35.4%). In almost three fourths of cases, the indications for using Palmer's point were previous laparotomy or the presence of large uterine fibroids. The next most common reasons for choosing Palmer's point were known documentation of intra-abdominal adhesions from prior laparoscopies, large ovarian cysts, and hernias or hernia repairs. Entry via Palmer's point was successful in all but two cases (98.5%), and there were no entry-related complications.
CONCLUSION(S): Our experience shows that laparoscopic entry using the left upper quadrant is safe with a low failure rate. Because the vast majority of gynecologic laparoscopies are done using subumbilical entry, it seems that Palmer's entry is underused by many gynecologists, despite it being safer in patients at risk of underlying adhesions and more appropriate in the presence of a large pelvic mass or a nearby hernia.
报告我们在妇科腹腔镜手术中使用 Palmer 点入路的经验。
回顾性观察性研究。
英国伦敦大学教学医院。
我们回顾了 2005 年 1 月 1 日至 2008 年 12 月 31 日期间在资深作者照顾下接受腹腔镜妇科手术的所有患者。
妇科腹腔镜手术。
使用 Palmer 入路的适应证、发生率、成功率和并发症。
385 例患者接受了腹腔镜手术。我们在 249 例（64.6%）中使用了脐部入路，在 136 例（35.4%）中使用了 Palmer 入路。在近四分之三的病例中，使用 Palmer 点的适应证是既往剖腹手术或存在大的子宫肌瘤。选择 Palmer 点的下一个最常见原因是已知有既往腹腔镜手术引起的腹腔内粘连、大卵巢囊肿、疝或疝修补术。除两例外（98.5%），Palmer 点入路均成功，无入路相关并发症。
我们的经验表明，左上方象限的腹腔镜入路是安全的，失败率低。由于绝大多数妇科腹腔镜手术都是通过脐下入路进行的，因此 Palmer 入路似乎被许多妇科医生低估了，尽管它在有潜在粘连风险的患者中更安全，在存在大盆腔肿块或附近疝时更合适。
