Childers J M, Brzechffa P R, Surwit E A
University of Arizona, Department of Obstetrics and Gynecology, Tucson 85712.
Gynecol Oncol. 1993 Aug;50(2):221-5. doi: 10.1006/gyno.1993.1196.
Laparoscopic surgery was performed on 41 patients who were at high risk for subumbilical adhesions because of either previous midline incisions through the umbilicus or umbilical hernias. Insufflation was performed using a Veress needle placed in the left upper quadrant in the 9th intercostal space. The primary trocar was placed in the left upper quadrant adjacent to the subcostal margin. Sixty-eight percent (28/41) of patients had subumbilical adhesions. One patient required laparotomy because of an enterotomy created when an 11-mm trocar was used. There were no complications in the remaining 40 patients, in whom smaller primary trocars were used. This is a safe location for primary trocar placement in patients at high risk for subumbilical adhesions, provided certain guidelines are followed.
对41例因既往经脐正中切口或脐疝而存在脐下粘连高风险的患者进行了腹腔镜手术。使用Veress针在左上方第9肋间间隙进行气腹。主套管针置于左上方靠近肋缘处。68%（28/41）的患者存在脐下粘连。1例患者因使用11毫米套管针时造成肠切开术而需要开腹手术。其余40例使用较小主套管针的患者未出现并发症。只要遵循某些指导原则，这是在存在脐下粘连高风险的患者中放置主套管针的安全位置。
