腹侧组织悬吊法在后腹腔镜手术中的应用

目的探讨腹侧组织悬吊法在后腹腔镜手术中的应用价值。方法 2010年3月～2011年9月在30例后腹腔镜手术中采用腹侧组织悬吊法,其中12例术中因侧椎筋膜"门帘效应"行腹侧组织悬吊固定术,18例因腹膜破裂行腹侧组织悬吊修复术。取1根中号圆针带针丝线,通过12 mm trocar通道置入后腹腔手术视野中,悬吊缝合腹侧侧椎筋膜,夹持缝线线头线尾通过腹侧trocar拉出,收紧缝线,保持腹侧侧椎筋膜悬吊,蚊式钳体外夹持缝线防止丝线回缩。结果 30例采用腹侧组织悬吊法处理中,12例腹侧筋膜"门帘效应"经处理后手术进展顺利;18例腹膜破裂采用腹侧组织悬吊法处理,其中15例处理后效果满意,手术顺利进行,3例效果不佳,采用脐部穿刺腹腔内留置5 mm trocar。术中未出现腹侧组织悬吊法相关并发症。结论腹侧组织悬吊法处理后腹腔镜术中腹侧筋膜"门帘效应"和腹膜破裂临床效果良好,具有经济、安全、简便的优势。

Ventral Abdominal Tissue Suspension for Retroperitoneoscopy

Objective To evaluate the value of ventral abdominal tissue suspension for retroperitoneoscopy.MethodsFrom March 2010 to September 2011,we performed ventral abdominal tissue suspension on 30 cases of retroperitoneoscopic surgery.Among the patients,12 cases received the procedure because of the curtain effect of the lateroconal fascia,the other 18 cases were due to peritoneal injury.With a 1# round needle,through a 12-mm trocar,we sutured the ventral lateroconal fascia,and then through the trocar again,pulled the both end of the suture and clipped it with a vascular clamp outside abdominal cavity to prevent the retraction of the suture.Results Among the 30 cases,the 12 patients with curtain effect,and 15 of the 18 patients,who had peritoneal injury,showed good outcomes.The procedure was failed in the other 3 patients,and therefore a 5-mm trocar was indwelt through a puncture at the umbilicus.No suspension-related complications occurred during the procedure.Conclusion Ventral abdominal tissue suspension is safe,convenient and economic for retroperitoneoscopy in the treatment of curtain effect of the lateroconal fascia and peritoneal injury.