Caprini J A, Arcelus J A, Swanson J, Coats R, Hoffman K, Brosnan J J, Blattner S
Department of Surgery, Glenbrook Hospital, Glenview, IL 60025, USA.
Surg Endosc. 1995 Mar;9(3):283-5. doi: 10.1007/BF00187769.
Laparoscopic candidates with abdominal scars may have adhesions that result in visceral injury during trocar insertion. The purpose of this study was to evaluate the use of preoperative ultrasound mapping of abdominal wall adhesions, to provide safe initial laparoscopic access, and to guide the placement of subsequent trocars, facilitating adhesolysis when necessary. Thirty consecutive patients with previous abdominal surgery who were scheduled for laparoscopy underwent a preoperative ultrasonic examination of the abdominal wall using a 7-MHz linear ultrasound probe. Spontaneous viscera slide was measured during longitudinal scanning (normal = 2-5 cm) and induced viscera slide was evaluated during longitudinal and transverse scanning (normal = 1 cm or more) over the existing abdominal scar, the peri-umbilical region, and the remaining abdominal quadrants. Sixteen (53%) of 30 patients had adhesions under their scar and only four patients (25%) had umbilical adhesions. The 12 patients without umbilical adhesions all had successful closed cannulation while open cannulation at alternate sites was successful in the four individuals with umbilical adhesions. Blind umbilical needle cannulation was successfully done in all of the remaining 14 patients (47%) without visceral injury, including three patients (21%) with upper abdominal scars who were adhesion-free elsewhere. No adhesions were encountered that had not been preoperatively predicted by ultrasound. We conclude that examination of the abdominal wall with spontaneous and induced viscera slide, using ultrasound scanning, can reliably detect intraabdominal adhesions. The examination is best done on a highly selective basis by the operating surgeon to guide the location for initial trocar insertion and determine the type of abdominal wall cannulation in those individuals with previous abdominal scars.
有腹部瘢痕的腹腔镜手术候选患者可能存在粘连，这会在穿刺套管插入过程中导致内脏损伤。本研究的目的是评估术前腹壁粘连的超声成像，以提供安全的初始腹腔镜入路，并指导后续穿刺套管的放置，必要时便于粘连松解。连续30例计划接受腹腔镜手术的既往有腹部手术史的患者，使用7兆赫线性超声探头对腹壁进行术前超声检查。在纵向扫描时测量自发内脏滑动（正常为2 - 5厘米），并在现有腹部瘢痕、脐周区域和其余腹部象限进行纵向和横向扫描时评估诱发内脏滑动（正常为1厘米或更多）。30例患者中有16例（53%）在瘢痕下方存在粘连，只有4例患者（25%）有脐部粘连。12例无脐部粘连的患者均成功进行了闭合插管，而4例有脐部粘连的患者在其他部位进行开放插管成功。其余14例患者（47%）均成功进行了盲法脐部穿刺插管且无内脏损伤，包括3例（21%）上腹部有瘢痕但其他部位无粘连的患者。未遇到术前超声未预测到的粘连。我们得出结论，使用超声扫描检查腹壁的自发和诱发内脏滑动，可以可靠地检测腹腔内粘连。该检查最好由手术医生在高度选择性的基础上进行，以指导初始穿刺套管插入的位置，并确定有腹部手术史患者的腹壁插管类型。
