Collinet P, Ballester M, Fauconnier A, Deffieux X, Pierre F
Service de gynécologie-obstétrique, CHU Jeanne de Flandres, 59000 Lille, France.
J Gynecol Obstet Biol Reprod (Paris). 2010 Dec;39(8 Suppl 2):S123-35. doi: 10.1016/S0368-2315(10)70039-9.
To provide guidelines for clinical practice from the French college of obstetrics and gynecology (CNGOF), based on the best evidence available, on laparoscopic entry techniques and technologies and their associated complications.
French and English-language articles from Medline, PubMed, and the Cochrane Database were searched, using the key words: laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, optical trocar radially expanded trocars, and laparoscopic complications.
Except for high-risk subgroups, laparoscopic entry should be performed using one of the four followings techniques (grade B): trans-umbilical trocar insertion after creation of a pneumoperitoneum using Veress needle; open-laparoscopy (Hasson technique), left upper quadrant (LUQ) laparoscopic entry or trans-ombilical direct trocart insertion. Because of insufficient evaluation, radially expanding trocars and visual entry systems (optical trocars) should not be used as a first-line technique (grade C). Left upper quadrant (LUQ, Palmer's) laparoscopic entry technique should be used in patients with previous midline incision laparotomy (grade B). In pregnant women, the level of insertion of the first trocar should be adapted to uterine volume (grade B). In second trimester, an open (Hasson) or a LUQ technique should be performed (grade C). In third trimester, an open (Hasson) technique (above the level of uterine fundus) should be performed when a laparoscopy is indicated. For pneumoperitoneum establishment using Veress needle insertion, one or several Veress needle safety tests or checks should be done (grade B) and waggling of the Veress needle from side to side must be avoided, as this can enlarge a bowel or vascular injury. In the Veress needle method of entry, the abdominal pressure should be increased immediately prior to insertion of the first trocar (from 15 to 25 mmHg) (grade C).
Implementation of this guideline should optimize the decision-making process in choosing a particular technique to enter the abdomen during laparoscopy.
基于现有最佳证据，为法国妇产科医师学会（CNGOF）提供关于腹腔镜进入技术、相关技术及其并发症的临床实践指南。
检索Medline、PubMed和Cochrane数据库中的法语和英语文章，关键词为：腹腔镜进入、腹腔镜入路、气腹、韦雷氏针、开放式（哈森）、直接套管针、可视化进入、带保护装置的套管针、光学套管针、径向扩张套管针和腹腔镜并发症。
除高危亚组外，腹腔镜进入应采用以下四种技术之一（B级）：使用韦雷氏针建立气腹后经脐套管插入；开放式腹腔镜检查（哈森技术）、左上腹（LUQ）腹腔镜进入或经脐直接套管针插入。由于评估不足，径向扩张套管针和可视化进入系统（光学套管针）不应作为一线技术使用（C级）。既往有中线剖腹手术史的患者应采用左上腹（LUQ，帕尔默氏点）腹腔镜进入技术（B级）。对于孕妇，第一套管针的插入位置应根据子宫体积进行调整（B级）。孕中期应采用开放式（哈森）或LUQ技术（C级）。孕晚期如需进行腹腔镜检查，应采用开放式（哈森）技术（在子宫底水平以上）。对于使用韦雷氏针插入建立气腹，应进行一项或多项韦雷氏针安全测试或检查（B级），且必须避免将韦雷氏针左右摆动，因为这可能会扩大肠管或血管损伤。在韦雷氏针进入法中，在插入第一套管针之前应立即增加腹腔压力（从15至25 mmHg）（C级）。
实施本指南应优化腹腔镜检查时选择特定腹部进入技术的决策过程。
