论文部分内容阅读
目的分析先前腹部手术对腹腔镜第一穿刺点的影响。方法将我院妇科行腹腔镜手术患者1970例作为研究对象,其中有腹部手术588例,先前无腹部手术1382例。所有患者脐孔第一穿刺按不同穿刺方法分为A组(常规气腹组),B组(切开皮肤穿刺组),C组(切开筋膜穿刺组)三组。结果先前无腹部手术的1382例患者中,第一穿刺点穿刺失败9例(0.6%),成功1373例;先前有腹部手术的588例患者中,失败10例(1.7%),成功578例(χ2=4.756,P<0.05)。从失败例数和努力次数来看,A组与B组相比,差异无统计学意义(P>0.05),C组与A组和B组相比,明显低于此两组(t=18.75和t=17.59,P<0.01)。先前无腹部手术患者,腹腔镜手术第一穿刺点三种方法并发症总体发生率2.5%(35/1 382)。先前有腹部手术,并发症总体发生率为6.3%(37/588),两者相比,差异有统计学意义(χ2=16.51,P<0.01)。C组并发症发生率与A组和B组相比差异有统计学意义(χ2=10.403,P<0.01),而A组与B组在并发症发生率方面差异无统计学意义(P>0.05)。结论先前有腹部手术史可以影响腹腔镜第一穿刺的成功率与并发症的发生率,在有腹部手术患者中腹腔镜第一穿刺可采用切开筋膜穿刺方法。
Objective To analyze the effect of previous abdominal surgery on the first laparoscopic puncture point. Methods 1970 cases of gynecological laparoscopic surgery in our hospital as a research object, of which 588 cases of abdominal surgery, abdomen surgery without previous 1382 cases. The first puncture of umbilicus in all patients was divided into three groups: group A (conventional pneumoperitoneum), group B (incision skin puncture group), group C (incision fascia puncture group) according to different puncture methods. Results Among the 1382 patients without abdominal surgery, the first puncture failed to puncture in 9 cases (0.6%), and the success rate was 1373. Of the 588 patients who previously had abdominal surgery, 10 failed (1.7%) and 578 χ2 = 4.756, P <0.05). There was no significant difference between group A and group B (P> 0.05). There was a significant difference between group C and group A and group B (t = 18.75 And t = 17.59, P <0.01). In the previous study, there was 2.5% (35/1 382) of the three complications in the first laparoscopic surgery without laparotomy. Previous abdominal surgery, the overall incidence of complications was 6.3% (37/588), the difference between the two was statistically significant (χ2 = 16.51, P <0.01). The incidence of complications in group C was significantly different from that in group A and group B (χ2 = 10.403, P <0.01), but there was no significant difference in the incidence of complications between group A and group B (P> 0.05 ). Conclusion The previous history of abdominal surgery can affect the success rate of laparoscopic first puncture and the incidence of complications in patients with abdominal surgery laparoscopic first puncture laparoscopic incision method can be used.