腹腔镜腹股沟疝修补术的电外科安全

目的:探讨腹腔镜腹股沟疝修补术中不同器械可能出现的电外科操作风险及相应的处理对策。方法:选取2010年1月至2012年1月行腹腔镜完全腹膜外疝修补术(totally extraperitoneal,TEP)的193例患者。详细统计其一般资料及手术时间,出、入液量,气腹压力等术中情况,对比单极电凝、绝缘剪刀及超声刀应用的时间、经常出现的术中问题等。结果:应用绝缘剪刀术中出血量、手术时间明显少于其他两种器械。意外气腹情况绝缘剪刀组发生1例,超声刀组发生13例,单极电凝组发生11例。结论:绝缘剪刀具有锐性切割组织、解剖层次清晰、术中牵拉及出血少、节约时间的特点,但对术中解剖要求较高。超声刀类产品由于气化及组织变性严重,会增加侧方损伤的几率。由于单极电凝的锐性切割效果较差、腹膜外空间小,更容易出现漏电及损伤腹膜的情况。

Electronic safety of laparoscopic inguinal herniorrhaphy

Objective： To investigate the threat of different electronic tools in laparoscopic inguinal herniorrhaphy,including insulated scissor,ultrasonic knife and single polar electrocoagulation,and the management of different threats. Methods： The clinical data of patients were collected from Jan. 2010 to Jan. 2012 who received totally extraperitoneal（ TEP） prosthesis in Shengjing hospital,and193 patients in total were included. All ordinary data,operative durations,total volumes of fluids in and out,pressure of abdominal cavity,the durations of different electronic tools and questions encountered in operations were summarized. Results： The volume of bleeding and operative time in scissor group were much less than those in the other two groups. Accident pneumoperitoneum question occurred in1 patient in scissor group,13 patients in ultrasound group and 11 patients in single polar electrocoagulation group. Conclusions： Insulated scissors have many advantages in TEP compared with other two methods,such as sharper dissection,easier distinguishwent of anatomical structure,less bleeding and less operative time,while it needs better skills in dissection. The shortcomings of ultrasonic knife are severe gasification and degeneration of tissues,and would result in lateral damage. Single polar electrocoagulation has no advantages in shape dissection and extraperitoneal space,would result in electric leakage and peritoneal injury.