Chang FH, Lee CL, Soong YK
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan, Taiwan, R.O.C.
J Am Assoc Gynecol Laparosc. 1994 Aug;1(4, Part 2):S7. doi: 10.1016/s1074-3804(05)80888-6.
Seventeen patients who had known or suspected intra-abdominal adhesions underwent laparoscopic surgery with the use of Palmer's Point for insertion of the operative laparoscope. Five of them were found to have extensive periumbilical adhesions. Intestinal or omental injury can occur if the trocar is inserted directly through the umbilical fossa. Though the incidence of direct trauma is reportedly low, there were still mild to moderate omental adhesions to the anterior abdominal wall, as we expected, in the remaining 12 patients. Possible inadequate aspiration and irrigation during laparoscopic removal of a dermoid cyst in one woman had resulted in severe postsurgical intraabdominal adhesions. More than two 10 mm incisions were used in our patients for insertion of the laparoscope interchangeablely to facilitate the procedure of laparoscopic adhesiolysis. The operative field can be expanded greatly. Fourteen patients completed the laparoscopic surgery, and the other 3 had alternative procedures eventually. No complications occurred during the laparoscopic procedure. The postoperative courses were uneventful in all 17 patients. Our experience suggests that Palmer's Point is a good alternative for insertion of the Veress needle and laparoscope in patients with previous laparotomies and suspected severe pelvic adhesions.
17例已知或疑似腹腔内粘连的患者接受了腹腔镜手术，通过Palmer点插入手术腹腔镜。其中5例发现有广泛的脐周粘连。如果套管针直接穿过脐窝插入，可能会发生肠管或网膜损伤。尽管据报道直接创伤的发生率较低，但正如我们所预期的，其余12例患者仍有轻度至中度的网膜与前腹壁粘连。一名女性在腹腔镜下切除皮样囊肿时可能存在抽吸和冲洗不充分的情况，导致术后严重的腹腔内粘连。我们的患者使用了两个以上10毫米的切口来交替插入腹腔镜，以方便腹腔镜粘连松解术的操作。手术视野可以大大扩展。14例患者完成了腹腔镜手术，另外3例最终采用了其他手术方式。腹腔镜手术过程中未发生并发症。所有17例患者术后恢复顺利。我们的经验表明，对于既往有剖腹手术且疑似严重盆腔粘连的患者，Palmer点是插入Veress针和腹腔镜的良好替代部位。
