Lee P I, Chi Y S, Chang Y K, Joo K Y
Gynecologic Endoscopy and Research Center, Samsung Cheil Hospital, Sungkyunkwan University, College of Medicine, Chung-ku, Seoul, Korea.
J Am Assoc Gynecol Laparosc. 1999 Feb;6(1):91-5. doi: 10.1016/s1074-3804(99)80048-6.
To evaluate the safety and efficacy of minilaparoscopy for visualization and adhesiolysis of intraabdominal adhesions for safe insertion of a primary umbilical cannula in patients who had previous pelvic or abdominal surgery.
Prospective, observational study (Canadian Task Force classification II-1).
University-affiliated hospital.
Twenty women who had previous pelvic or abdominal surgery, excluding tubal ligation and simple appendectomy.
Minilaparoscopy was carried for visualization and adhesiolysis at the entry site before insertion of an umbilical cannula.
Eleven patients had Pfannenstiel scars and nine had vertical midline scars from previous surgeries (4 total abdominal hysterectomies, 13 adnexal surgery, 7 cesarean sections, 3 ectopic pregnancies, 1 ruptured appendix, 1 unknown bowel surgery). Thirteen women (65%) had had one previous surgery, five (25%) had had two, and two (10%) had had three. Nine patients (45%) had significant adhesions of omentum or intestine that required adhesiolysis. Mean operating time for minilaparoscopy was 5 minutes for 11 women who had no or minimal adhesions that did not interfere with safe insertion of the umbilical cannula and effective use of a 10-mm telescope, and 25 minutes in 9 patients who required adhesiolysis before insertion of the umbilical cannula because of dense adhesions of omentum or intestine at the entry site. No complications with minilaparoscopy occurred.
Minilaparoscopy can be performed safely and effectively to reduce serious vascular or visceral injury from insertion of primary cannula in patients who had previous pelvic and/or abdominal surgery. However, conclusions cannot be derived from this study due to the small number of subjects. Further study is necessary in a larger patient population to evaluate efficacy, safety, and advantages of minilaparoscopy over other techniques. (J Am Assoc Gynecol Laparosc 6(1):91-95, 1999)
评估微型腹腔镜检查对于曾接受盆腔或腹部手术患者腹腔粘连可视化及粘连松解的安全性和有效性，以便安全插入初次脐部套管。
前瞻性观察性研究（加拿大工作组分类II-1）。
大学附属医院。
20名曾接受盆腔或腹部手术的女性，不包括输卵管结扎术和单纯阑尾切除术。
在插入脐部套管前，进行微型腹腔镜检查以观察进入部位并松解粘连。
11名患者有Pfannenstiel切口瘢痕，9名患者有既往手术留下的垂直中线瘢痕（4例全腹子宫切除术、13例附件手术、7例剖宫产、3例异位妊娠、1例阑尾破裂、1例不明肠道手术）。13名女性（65%）曾接受过一次手术，5名（25%）曾接受过两次手术，2名（10%）曾接受过三次手术。9名患者（45%）有大网膜或肠道的显著粘连，需要进行粘连松解。对于11名无粘连或仅有不影响脐部套管安全插入及10毫米腹腔镜有效使用的轻微粘连的女性，微型腹腔镜检查平均手术时间为5分钟；对于9名因进入部位大网膜或肠道致密粘连而在插入脐部套管前需要进行粘连松解的患者，平均手术时间为25分钟。微型腹腔镜检查未发生并发症。
对于曾接受盆腔和/或腹部手术的患者，微型腹腔镜检查可安全有效地进行，以减少初次套管插入时严重的血管或内脏损伤。然而，由于受试者数量较少，无法从本研究得出结论。有必要在更大的患者群体中进行进一步研究，以评估微型腹腔镜检查相对于其他技术的疗效、安全性和优势。（《美国妇科腹腔镜医师协会杂志》6(1):91-95，1999年）
