经脐入路腹腔镜手术不同打结方法结质量的评估

目的评估3种经脐人路内镜手术（transumbilical endoscopic surgery, TUES）打结方法所做结的强度。方法用腹腔镜操作模拟训练箱和SILSport建立TUES操作平台。分别用腔内侧绕、单手“O”形和腔外推结器打结法打结，并用常规腹腔镜打结技术作为对照。每组均完成打结操作8次。用万能材料试验机对形成的结进行牵引，测定拉脱各组结所需力的大小。结果各组结拉脱所需力：腹腔镜打结组（8．75±0．51）N，腔内侧绕打结组（7．81±0．45）N，腔外推结器打结组（8．35±0．87）N，腔内单手“O”形打结组（8．64±0．29）N。侧绕打结组所做结被拉脱所用力明显小于作为对照的腹腔镜打结组（P=0．003）和单手打结组（P=0．006）。结论三种打结方法中，腔内侧绕打结组所做结拉开用力最小，说明该方法所作结质量最低；同时，单手和腔外推结器打结组拉脱所用力与对照组（常规腹腔镜打结）无显著差别，说明这两种打结方法能达到常规腹腔镜打结技术所做结的牢固程度。

The Assessment of Three Knot-tying Techniques in Transumbilical Endoscopic Surgery Using a Material Testing System

Objective To assess the quality of knots with three different knot-tying techniques in transumbilieal endoscopic surgery （TUES） using a universal material testing system. Methods Three knot-tying techniques were tested in this study, ineluding intraeorporeal ＂side winding＂ knot-tying （ISK） , intracorporeal one-handed knot-tying （IOK） , and extraeorporeal knot-tying （EK）. Conventional laparoscopie knot-tying （CLK） technique was used as a control. The forces that caused the knots to rupture were measured using a material testing system to compare the knots＇ strength. Knot-tying was accomplished for 8 times respectively in all the four groups. Results The forces that caused the knots to rupture were （8.75 ±0.51） N （CLK group）, （7.81 ±0.45） N （ISK group） , （8.35 ± 0.87） N （ EK group） and （8.64 ± 0.29） N （ IOK group） respectively. It took less force to loosen the knots in ISK group compared with those in CLK and IOK groups respectively （P = 0. 003,0. 006）. Conclusions Intracorporeal one-handed and extraeorporeal knots can tolerate greater forces than intracorporeal ＂side winding＂ knots when tested in laboratory settings, which shows that the quality of knots in ISK group is the worst. No significant difference was detected in the forces used among the CLK, the EK and the IOK group, thus we conclude that the knots in EK and IOK groups are as firm as in CLK group.