天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (12): 1330-1333.doi: 10.11958/20170755

• 临床研究 • 上一篇    下一篇

腹腔镜后腹腔间隙建立失误分析及经验总结

崔小健 1， 丛桂成 1， 姚庆祥 1， 李伯全 2   

  1. 作者单位： 1 天津市泰达医院泌尿外科 （邮编 300450）； 2 中国人民解放军第二五四医院泌尿外科 作者简介： 崔小健 （1980）， 男， 硕士， 主治医师， 主要从事泌尿外科腔镜等研究
  • 收稿日期:2017-06-29 修回日期:2017-10-26 出版日期:2017-12-15 发布日期:2017-12-15
  • 通讯作者: 崔小健 E-mail:pawanmei@163.com

Error analysis and experience summary in setting up the retroperitoneal cavity for peritoneoscopy

CUI Xiao-jian1, CONG Gui-cheng1, YAO Qing-xiang1, LI Bo-quan2   

  1. 1 Department of Urological Surgery, Tianjin TEDA Hospital, Tianjin 300450, China; 2 Department of Urological Surgery, No. 254 Hospital of Chinese People’ s Liberation Army
  • Received:2017-06-29 Revised:2017-10-26 Published:2017-12-15 Online:2017-12-15

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摘要： 目的 探讨建立后腹腔间隙过程中存在的失误及其原因。方法 收集 2009 年 5 月—2016 年 12 月在我 科完成的后腹腔镜手术患者 450 例临床资料， 根据穿刺位点分为腰部组 （193 例） 和髂嵴上组 （276 例）。总结在建立 后腹腔间隙过程中出现的失误并分析其原因。结果 在后腹腔间隙建立过程中出现了腹膜破裂 （10 例）、 气囊扩张 间隙错误（5 例）、 自制气囊破裂脱落及排气不畅（7 例）、 穿刺套管位置不佳（34 例）、 穿刺通道出血（6 例）、 套管周围 漏气、 皮下气肿等失误， 分别采用了腹膜修补、 重新建立扩张间隙、 调整套管位置等相应措施进行处理。450 例患者 手术均顺利完成。结论 应根据患者的不同情况选择合适的建腔方式， 同时应熟悉腹膜后腔的解剖， 注重后腹腔间 隙建立过程中各个细节， 减小失误的发生。

关键词: 腹腔镜检查, 后腹腔镜下, 腹膜后腔, 失误

Abstract: Objective To explore errors and their causes in setting up the retroperitoneal cavity for peritoneoscopy. Methods The clinical data of 450 patients who were performed the laparoscopic surgery in our hospital from May 2009 to December 2016 were collected. According to the trocar puncture points, patients were divided into lumbar group (n=193) and iliac flap group (n=276). The problems were summarized and analyzed in the process of setting up the retroperitoneal cavity. Results The mistakes existed in setting up the retroperitoneal cavity including peritoneum rupture (10 cases), error in balloon expansion clearance (5 cases), homemade balloon rupture and fall off (7 cases), poor position of puncture port (34 cases), bleeding of puncture channel (6 cases), leaking around the trocar and subcutaneous emphysema. After peritoneal patching, re-establishment of the expansion of the gap, adjusting the trocar position and other appropriate measures for treatment, the operations were successfully in 450 patients. Conclusion We should choose the appropriate method for building cavity according to different conditions of patients, and know well the anatomy of the peritoneal cavity. All details should be emphasized in the process of building cavity to reduce the occurrence of errors.

Key words: laparoscopy, retroperitoneoscopy, retroperitoneal space, errors