Smith R S, Fry W R, Tsoi E K
Department of Surgery, University of California, Oakland, USA.
Surg Laparosc Endosc. 1995 Oct;5(5):387-92.
The purpose of this study was to assess the capability of a retractor system that permits laparoscopic surgery without carbon dioxide pneumoperitoneum and to determine if the system facilitates the use of traditional surgical instruments during minimally invasive surgery. This study was performed at a university-affiliated county hospital (Alameda County Medical Center, Highland General Hospital campus) in Oakland, California. The study design was prospective evaluation with data collection. Eighty-eight isopneumic laparoscopic procedures were performed between July 1992 and October 1993. A planar abdominal wall distention system consisting of an intra-abdominal fan retractor and an electrically powered mechanical arm was used to provide exposure. Conventional surgical instruments as well as laparoscopic instruments were used in each case. Laparoscopy without pneumoperitoneum was used in the evaluation of 43 patients with abdominal trauma (gunshot wound, 18; stab wound, 19; blunt trauma, 6). The need for formal abdominal exploration was obviated in 35 of 43 (81%) cases. Repair of three enterotomies, four diaphragmatic lacerations, and one gastric perforation was performed with conventional instruments. Isopneumic laparoscopic techniques were also used for cholecystectomy (n = 36), diagnosis laparoscopy (n = 4), appendectomy (n = 3), sigmoidopexy (n = 1), and closure of a perforated duodenal ulcer (n = 1). Abdominal exposure approximating that obtained by pneumoperitoneum was obtained in 37 of 45 cases. One major (trocar tip enterotomy) and two minor complications (superficial wound infection) occurred in this group of patients. The ability to use traditional surgical instruments was advantageous in several cases. Laparoscopic surgical procedures can be performed without pneumoperitoneum in the majority of cases. The ability to use conventional surgical instruments is an advantage of this technique. Further improvements in abdominal wall distention systems and modifications of existing surgical instruments are required to further expand the role of isopneumic laparoscopy.
本研究的目的是评估一种允许在无二氧化碳气腹情况下进行腹腔镜手术的牵开器系统的性能，并确定该系统在微创手术过程中是否便于使用传统手术器械。本研究在加利福尼亚州奥克兰市一家大学附属县级医院（阿拉米达县医疗中心，高地综合医院院区）进行。研究设计为带有数据收集的前瞻性评估。1992年7月至1993年10月间进行了88例等气腹腹腔镜手术。使用了一种由腹腔内扇形牵开器和电动机械臂组成的平面腹壁扩张系统来提供暴露。每种情况下均使用了传统手术器械以及腹腔镜器械。在对43例腹部创伤患者（枪伤18例；刺伤19例；钝性创伤6例）的评估中采用了无气腹腹腔镜检查。43例中的35例（81%）无需进行正式的腹部探查。使用传统器械对3处肠切开、4处膈肌裂伤和1处胃穿孔进行了修复。等气腹腹腔镜技术还用于胆囊切除术（n = 36）、诊断性腹腔镜检查（n = 4）、阑尾切除术（n = 3）、乙状结肠固定术（n = 1）以及穿孔性十二指肠溃疡闭合术（n = 1）。45例中的37例获得了接近气腹所达到的腹部暴露。该组患者发生了1例严重并发症（套管针尖端肠切开）和2例轻微并发症（浅表伤口感染）。在一些情况下，使用传统手术器械的能力具有优势。大多数情况下，腹腔镜手术可以在无气腹的情况下进行。能够使用传统手术器械是该技术的一个优点。需要进一步改进腹壁扩张系统并对现有手术器械进行改良，以进一步扩大等气腹腹腔镜检查的作用。
