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犬卵巢切除术腹腔镜手术中Veress针技术与改良Hasson技术首次穿刺孔放置时间及并发症发生率的比较

A Comparison of Times Taken for the Placement of the First Portal and Complication Rates between the Veress Needle Technique and the Modified Hasson Technique in Canine Ovariectomy Laparoscopic Surgery.

作者信息

Bianchi Amanda, Collivignarelli Francesco, Vignoli Massimo, Scaletta Lorenzo, Cuomo Amedeo, Falerno Ilaria, Paolini Andrea, Tamburro Roberto

机构信息

Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy.

Veterinaria Enterprise Stp S.R.L., Via Galvani 33d, 00153 Rome, Italy.

出版信息

Animals (Basel). 2021 Oct 11;11(10):2936. doi: 10.3390/ani11102936.

Abstract

Minimally invasive surgery is increasingly being used in veterinary medicine. Laparoscopic procedures have several advantages compared with open surgery. These include the magnification of the field of surgery, reduced post-surgical pain and associated stress, reduced post-operative infection rates, and decreased hospitalization time. The establishment of a pneumoperitoneum is a critical step; however, this procedure can prolong the operation time, and most of the complications associated with laparoscopic surgery have been attributed to the insertion of devices into the abdominal cavity. Two main techniques have been employed to create pneumoperitoneum: the closed-entry method using the Veress needle and the open Hasson technique. The first portal is necessary to start insufflation and, subsequently, to realize the operative channel to insert the laparoscopic instruments into the abdomen. Many authors have compared the time necessary to create the first portal using different techniques in human medicine, but studies on this topic in veterinary medicine are lacking. In the veterinary medicine literature, complications associated with the creation of a pneumoperitoneum and the placement of ports include spleen, bowel, or bladder injuries; pneumothorax; and subcutaneous emphysema. The aim of the present study was to compare the times required for the placement of the first portal and the creation of pneumoperitoneum, and the rates of intraoperative complications using the Veress needle technique (VNT) and the open modified Hasson technique (MHT). The sample population comprised 30 female dogs who underwent laparoscopic ovariectomies. The dogs were randomly organized into two groups and two different entry techniques were used: Veress needle (VNT = group A) and the modified Hasson technique (MHT = group B). Complications related to abdominal entry were classified as major, in cases of organ perforation, and minor, in cases of subcutaneous emphysema and gas leakage. The VNT and MHT required 374.0 s and 242.9 s, respectively, for the placement of the first portal and for establishing pneumoperitoneum ( < 0.05). Their major complications rates were 20% and 0%, respectively ( < 0.05). Their minor complications rates were 20% and 35%, respectively ( < 0.05). No surgical procedures required laparotomy. The MHT was associated with a lower major complication rate and required less time to create the first portal, compared with the Veress needle technique.

摘要

微创手术在兽医学中的应用越来越广泛。与开放手术相比,腹腔镜手术有几个优点。这些优点包括手术视野放大、术后疼痛和相关应激反应减轻、术后感染率降低以及住院时间缩短。建立气腹是关键步骤;然而,此操作会延长手术时间,且大多数与腹腔镜手术相关的并发症都归因于将器械插入腹腔。已采用两种主要技术来创建气腹:使用Veress针的闭合入路法和开放的Hasson技术。第一个穿刺孔对于开始充气以及随后实现将腹腔镜器械插入腹腔的手术通道是必要的。许多作者在人类医学中比较了使用不同技术创建第一个穿刺孔所需的时间,但兽医学中关于此主题的研究较少。在兽医学文献中,与创建气腹和放置穿刺孔相关的并发症包括脾脏、肠道或膀胱损伤;气胸;以及皮下气肿。本研究的目的是比较使用Veress针技术(VNT)和开放改良Hasson技术(MHT)放置第一个穿刺孔和创建气腹所需的时间,以及术中并发症的发生率。样本群体包括30只接受腹腔镜卵巢切除术的雌性犬。这些犬被随机分为两组,并使用两种不同的入路技术:Veress针(VNT = A组)和改良Hasson技术(MHT = B组)。与腹部入路相关的并发症在器官穿孔的情况下被分类为严重并发症,在皮下气肿和气体泄漏的情况下被分类为轻微并发症。放置第一个穿刺孔并建立气腹时,VNT和MHT分别需要374.0秒和242.9秒(P<0.05)。它们的严重并发症发生率分别为20%和0%(P<0.05)。它们的轻微并发症发生率分别为20%和35%(P<0.05)。没有手术需要剖腹探查。与Veress针技术相比,MHT的严重并发症发生率较低,且创建第一个穿刺孔所需时间更少。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/023d/8532732/f58f3286c859/animals-11-02936-g001.jpg

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