切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2016, Vol. 09 ›› Issue (03): 183 -186. doi: 10.3877/cma.j.issn.1674-6899.2016.03.015

所属专题： 文献资源库；

综述 上一篇    下一篇

腹部腹腔镜手术空间建立方法的进展
张凯 1, 徐安安 1, 胡海 1 , †( )   
  1. 1. 200120 上海，同济大学附属东方医院肝胆胰外科
  • 收稿日期:2016-03-16 出版日期:2016-06-30
  • 通信作者: 胡海
  • 基金资助:
    上海市卫生局重点课题(20114017)

Advances of operation field establishing methods for abdominal laparoscopic surgery

Kai Zhang 1, Anan Xu 1, Hai Hu 1 , †( )   

  1. 1. Department of Hepatopancreatobiliary Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
  • Received:2016-03-16 Published:2016-06-30
  • Corresponding author: Hai Hu
  • About author:
    Corresponding author: Hu Hai, Email:
全文 ( ) 下载PDF ( )

二氧化碳气腹是目前腹部腹腔镜手术中最主要的术野建立方式，但会对患者术中的心肺功能、血流动力学、肾功能等方面产生不良影响，术后可能导致静脉血栓、肩疼痛、气体栓塞等并发症，甚至可使游离肿瘤细胞在腹腔内播散，而改变媒介气体(如N2O、氦气等)只能减少一小部分并发症，并且不适用于因心肺功能差无法耐受气腹手术的患者。因此，提升腹壁术野建立方法应运而生，使不能耐受气腹手术的患者获得了微创治疗的机会，还可以避免气体填充所致的并发症。但现有提升式腹部空间建立方法都存在手术空间显露不足的缺陷。笔者对国内外现有腹部腹腔镜手术空间建立方法进行综述，提出以"填充式"和"提升式"对腹部腹腔镜手术空间建立方法进行分类，并对腹部腹腔镜技术手术空间建立方法作出展望。

关键词: 气腹, 腹腔镜, 腹部

Nowdays CO2 pneumoperitoneum is the main way to establish operation field in abdominal laparoscopic surgery, but it may have side effects on patients of their cardiopulmonary function, hemodynamics and kidney function during the surgery, and may cause postoperative venous thrombosis, shoulder pain, gas embolism, etc, even the spread of tumor cells inside of abdomen. Changing the medium gas such as N2O, Helium, etc, can only reduce a few complications of above mentioned, and it does not apply to patients who cannot tolerate pneumoperitoneum surgery because of poor cardiopulmonary function. Therefore, methods that establish operation field by lifting abdominal wall emerge and avoid complications caused by gas filling which make the surgery for those patients who cannot tolerate pneumoperitoneum possible. However, the existing methods have defects of insufficient exposure of operation field. This paper reviewed and summarized the existing field establishing methods for abdominal laparoscopic surgery of domestic and international, proposed to classify the operation field establishing methods for abdominal laparoscopic surgery by 'filling method’ and 'lifting method’, and made expectation about the development and perfection of existing operation field establishing methods for abdominal laparoscopic surgery.

Key words: Pneumoperitoneum, Laparoscopes, Abdomen
1
Eyas, Alkhalili, Eren. Laparoscopic liver resection for malignancy: a review of the literature[J]. World Journal of Gastroenterology, 2014, 20(37): 13599-13606.
2
Croce E, Azzola M, Russo R, et al. Laparoscopic colectomy: the absolute need for a standard operative technique[J]．Jsls Journal of the Society of Laparoendoscopic Surgeons, 1997, 1(3): 217-224.
3
Sexton JA, Pierce RA, Halpin VJ, et al. Laparoscopic gastric resection for gastrointestinal stromal tumors[J]．Surgical Endoscopy, 2008, 22(12): 2583-2587.
4
Dong JK, Wook K. Laparoscopic completion total gastrectomy for remnant gastric cancer following pancreaticoduodenectomy for bile duct cancer: a case report[J]．Annals of Surgical Treatment and Research, 2016, 90(2): 106-110.
5
Ho HS, Gunther RA, Wolfe BM. Intraperitoneal carbon dioxide insufflation and cardiopulmonary functions: laparoscopic cholecystectomy in pigs[J]．Archives of Surgery, 1992, 127(8): 932-933.
6
Leighton TA, Liu SY, Bongard FS. Comparative cardiopulmonary effects of carbon dioxide versus helium pneumoperitoneum[J]．Surgery, 1993, 113(5): 527-531.
7
Litwack K, Parnass S. Practical points in the management of postoperative nausea and vomiting[J]．Journal of Post Anesthesia Nursing, 1988, 3(4): 275-277.
8
Jorgensen JO, Lalak NJ, North L, et al. Venous stasis during laparoscopic cholecystectomy[J]．Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 1994, 4(2): 128-133.
9
Joris J, Thiry EP, Weerts J, et al. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine[J]. Anesthesia & Analgesia, 1995, 81(2): 379-384.
10
Abe H , Bandai Y , Ohtomo Y , et al. Extensive subcutaneous emphysema and hypercapnia during laparoscopic cholecystectomy: two case reports[J]．Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 1995, 5(3): 183-187.
11
Cobb WS, Fleishman HA, Kercher KW, et al. Gas embolism during laparoscopic cholecystectomy[J]．Journal of Laparondoscopic & Advanced Surgical Techniques Part A, 2005, 15(4): 387-390.
12
Angst E, Hiatt JR, Gloor B, et al. Laparoscopic surgery for cancer: a systematic review and a way forward[J]．Journal of the American College of Surgeons, 2010, 211(3): 412-423.
13
Hamad MA, El-Khattary OAI. Laparoscopic cholecystectomy under spinal anesthesia with nitrous oxide pneumoperitoneum: a feasibility study[J]. Surgical Endoscopy, 2003, 17(9): 1426-1428.
14
Bickel A, Kukuev E, Popov O, et al. Power spectral analysis of heart rate variability during helium pneumoperitoneum: the mechanism of increased cardiac sympathetic activity and its clinical significance[J]．Surgical Endoscopy, 2005, 19(1): 71-76.
15
Makarov DV, Daraspreet K, Link RE, et al. Physiologic changes during helium insufflation in high-risk patients during laparoscopic renal procedures[J]．Urology, 2007, 70(1): 35-37.
16
Rammohan A, Manimaran AB, Manohar RR, et al. Nitrous oxide for pneumoperitoneum: no laughing matter this! a prospective single blind case controlled study[J]．International Journal of Surgery, 2011, 9(2): 173-176.
17
Gordts S, Campo R, Brosens I. Office transvaginal hydrolaparoscopy for early diagnosis of pelvic endometriosis and adhesions[J]．Journal of the American Association of Gynecologic Laparoscopists, 2000, 7(1): 45-49.
18
Moore ML, Mel C, Liu GY. Experience with 109 cases of transvaginal hydrolaparoscopy[J]. Journal of the American Association of Gynecologic Laparoscopists, 2003, 10(2): 282-285.
19
邹敏，叶萍，胡小良，等. 经阴道注水腹腔镜在盆腔疾病诊治中的应用[J]．中国计划生育和妇产科，2009，1(3): 32-36.
20
夏恩兰，崔恒. 经阴道注水腹腔镜[J]．国际妇产科学杂志，2003, 30(5): 329-331.
21
Ahinko-Hakamaa KM, Huhtala H, Tinkanen H. Confirmation of tubal patency in hysterosalpingo-contrast sonography by transvaginal hydrolaparoscopy[J]．Acta Obstetricia Et Gynecologica Scandinavica, 2009, 88(3): 286-290.
22
Nagai H, Inaba T, Kamiya S, et al.A new method of laparoscopic cholecystectomy: an abdominal wall lifting technique without pneumoperitoneum[J]．Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 1991, 1(2): 126-129.
23
Hashimoto D, Nayeem SA, Kajiwara S, et al. Abdominal wall lifting with subcutaneous wiring: an experience of 50 cases of laparoscopic cholecystectomy without pneumoperitoneum[J]. Surgery Today, 1993, 23(9): 786-790.
24
Nakamura H, Kobori Y, Goseki N, et al. Fishing-rod-type abdominal wall lifter for gasless laparoscopic surgery[J]. Surgical Endoscopy, 1996, 10(9): 944-946.
25
Alker K. Keyless abdominal rope-lifting surgery (KARS)[J]. Surgery Current Research, 2013, 1(7): 1076-2161.
26
Smith RS, Fry WR, Tsoi EK, et al. Gasless laparoscopy and conventional instruments.the next phase of minimally invasive surgery[J]．Archives of Surgery, 1993, 128(10): 1102-1107.
27
Smith RS, Fry WR, Tsoi EK, et al. Gasless laparoscopy and conventional instruments. The next phase of minimally invasive surgery[J]. Archives of Surgery, 1993, 128(10): 1102-1107.
28
王秋生，邓绍庆，黄庭，等. 自制非气腹装置在腹腔镜外科手术中的应用[J]. 中华外科杂志，1995(1): 15-18.
29
Chang FH, Soong YK, Cheng PJ, et al. Laparoscopic myomectomy of large symptomatic leiomyoma using airlift gasless laparoscopy: a preliminary report[J]. Human Reproduction, 1996, 11(7): 1427-1432.
30
Izumi Y, Kawano T, Iwai T. Development and clinical application of semi-loop-shaped retractor for gasless laparoscopic surgery[J]. Surgical Endoscopy, 2003, 17(9): 1488-1493.
31
杜运生，周志祥，张景华，等. 单孔非气腹腹腔镜的实验研究[J]. 中国微创外科杂志，2006，6(3): 229-231.
32
丁胜文，赵敏健. 可折悬吊拉钩在非气腹腹腔镜手术中的应用[J]. 中华实验外科杂志，1997，14(2): 98-99.
33
阮景德，张晓波，夏征，等. 腹壁提升免气腹腹腔镜手术[J]. 中国内镜杂志，2001，7(3): 19-20.
34
Akira S, Abe T, Igarashi K, et al. Gasless laparoscopic surgery using a new intra-abdominal fan retractor system: an experience of 500 cases[J]. Journal of Nippon Medical School, 2005, 72(72): 213-216.
35
Tung-Cheng C, Ming-Hsun W, Yao-Ming W, et al. Technical innovation: gasless laparoscopic hepatectomy using self-designed abdominal lifting system[J]. Journal of Laparoendoscopic & Advanced Surgical Techniques Part A, 2009, 19(4): 541-544.
36
Tung-Cheng C, Chien-Chia C, Ming-Yang W, et al. Gasless laparoscopy-assisted distal gastrectomy for early gastric cancer: analysis of initial results[J]. Journal of Laparoendoscopic & Advanced Surgical Techniques, 2011, 21(3): 215-220.
37
Lee PC, Lai PS, Yang CY, et al. A gasless laparoscopic technique of wide excision for gastric gastrointestinal stromal tumor versus open method[J]. World Journal of Surgical Oncology, 2013, 11(1): 1-7.
38
Gazayerli MM. The Gazayerli endoscopic retractor model 1[J]. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 1991, 1(2): 98-100.
39
Kitano S, Moriyama M, Sugimachi K. Laparoscopy-assisted abdominal surgery for common bile duct stones[J]. Endoscopy, 1992, 24(9): 804.
40
Kitano S, Tomikawa M, Iso Y, et al. A safe and simple method to maintain a clear field of vision during laparoscopic cholecystectomy[J]. Surgical Endoscopy, 1992, 6(6): 197-198.
41
王秋生，刘隆，冀涛，等. 非气腹装置的研制与非气腹腹腔镜手术的临床应用[J/CD]. 中华腔镜外科杂志：电子版，2005, 1(1): 6-9.
42
Dongbo W, Kuihua G, Zerong F, et al. Spindle-like abdominal wall-lifting device in gasless laparoscopic surgery in animal experiments[J]. Minimally Invasive Therapy & Allied Technologies Mitat Official Journal of the Society for Minimally Invasive Therapy, 2014, 23(6): 357-360.
43
崔建新，卢灿荣，卫勃，等. 新型免气腹悬吊装置研制及应用[J]. 中国医学装备，2015，12(11): 21-23.
44
Volland M, Lienert M, Horstmann O. Gasless balloon laparoscopy[J]. Surgical Endoscopy, 2010, 24(7): 1566-1572.
[1] 王玉, 盛洁, 靳灵鸽, 蒋子文, 卢丹. 不同止血方式对腹腔镜下卵巢子宫内膜异位囊肿剥除术后卵巢储备功能的影响[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(04): 420-424.
[2] 吴丰信, 吴英光, 俞建雄, 王胜. 腹腔镜辅助保留幽门胃部分切除术治疗早期胃中部癌近期疗效分析[J]. 中华普通外科学文献(电子版), 2021, 15(05): 326-330.
[3] 周仕海, 陈宏, 张静, 雒洪志, 冯春在, 孙浩, 钟思全. 结直肠肿瘤经自然腔道取出标本手术67例分析[J]. 中华普通外科学文献(电子版), 2021, 15(05): 340-343.
[4] 曹利, 李建伟. 腹腔镜前入路解剖性右半肝切除术[J]. 中华普外科手术学杂志(电子版), 2021, 15(04): 375-375.
[5] 术者：张树彬 助手：邢中强 段佳悦 李昂 指导老师：刘建华 剪辑：徐晨. 健侧先行原位右半肝+全尾状叶切除的腹腔镜肝门部胆管癌根治术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[6] 褚薛慧. 腹腔镜肝右后叶切除术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[7] 卢攀 刘心怡 李坚 陈龙 张伟. 经脐单孔腹腔镜左半肝切除术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[8] 张硕, 杨军, 顾元龙. 腹腔镜胆囊切除术致胆道损伤的危险因素及处理[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 470-473.
[9] 吴志明, 黄洪军, 孟兴成, 葛佳皓, 沈丽青, 胡常恩, 虞洪. ERAS理念在腹腔镜胆总管切开取石一期缝合术中的应用[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 474-478.
[10] 丁天龙, 谷保红, 李雪梅, 胡继科, 张凡, 冯泽东, 马斌, 王琛, 陈昊. "脱衣法"腹腔镜胆囊切除术的应用[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 498-501.
[11] 王峰杰, 陈焕伟, 刘颖, 雷秋成, 宁燕文. 腹腔镜胰体尾切除手术入路及安全性[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 506-509.
[12] 李国林, 王秀, 陈桂婵, 邱逸红. 腹腔镜胰十二指肠切除术围手术期标准化管理[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 510-513.
[13] 李涛, 吐尔洪江·吐逊, 沙地克·阿帕尔, 白磊, 曹峻, 何翼彪, 王智鹏, 赵晋明. 全腹腔镜活体供肝右半肝切取术一例并文献复习[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 514-518.
[14] 闫顺笠, 孙慧敏, 郑朝旭, 刘正, 陈海鹏, 关旭, 庄孟, 黄海洋, 王锡山, 裴炜. 全腹腔镜右半结肠癌根治术后肠梗阻一例并文献复习[J]. 中华结直肠疾病电子杂志, 2021, 10(04): 427-431.
[15] 蓝炘, 朴成林, 安峰铎, 谈明坤, 司振铎, 吴蔚, 赵娜, 冷建军. 3D腹腔镜与2D腹腔镜下肝癌切除术的短期疗效比较[J]. 中华临床医师杂志(电子版), 2021, 15(05): 327-330.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号