Improved application of the first trocar placement for pneumoperitoneum in laparoscopic upper urinary tract tumor surgery through lateral transabdominal approach
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摘要: 目的 探讨侧入路经腹腔途径腹腔镜上尿路肿瘤手术气腹建立第一套管置入2种方法的临床效果。方法 回顾性分析2019年1月—2021年12月在重庆医科大学附属永川医院行侧入路经腹腔途径腹腔镜上尿路肿瘤手术患者的病例资料。共纳入患者113例，其中Veress气腹针组51例，改良Hasson组62例。比较2组患者的手术安全指标、是否离断肌肉、疼痛评分及并发症等。结果 2组患者的一般资料差异无统计学意义(P>0.05)。改良Hasson组与Veress气腹针组第一套管建立时间、出血量、CO2泄露、血管损伤、皮下气肿及下肢静脉血栓形成等方面差异无统计学意义(P>0.05)。改良Hasson组在是否离断肌肉、术后VAS疼痛评分及术后住院时间方面具有显著优势，差异有统计学意义(P < 0.001、P=0.03、P=0.01)。结论 改良Hasson技术在侧入路腹腔镜上尿路肿瘤手术建立气腹第一套管中是一种安全、有效、微创的方式，其并发症少、创伤小、术后快速康复为重要优势。对于标本较大的患者尤其适宜。Abstract: Objective To explore the clinical effect of two methods of establishing the first trocar in pneumoperitoneum for laparoscopic upper urinary tract tumor surgery through lateral transabdominal approach.Methods The data of patients undergoing laparoscopic upper urinary tract tumor surgery via lateral transabdominal approach in Yongchuan Hospital of Chongqing Medical University from January 2019 to December 2021 were analyzed retrospectively. Totally 113 cases were included, including 51 cases in the Veress group and 62 cases in the modified Hasson group. The surgical safety index, muscle amputation, pain score and complications of the two groups were compared.Results There was no significant difference in general data between the two groups(P>0.05). There was no significant difference between the modified Hasson group and the Veress group in the first trocar establishment time, blood loss, CO2 leakage, vascular injury, subcutaneous emphysema or lower limb vein thrombosis(P>0.05). The modified Hasson group had significant advantages in muscle injury, postoperative AVS pain score and postoperative hospital stay(P < 0.001, P=0.03, P=0.01).Conclusion The modified Hasson technique is a safe, effective and minimally invasive way to establish the first trocar in the laparoscopic surgery through lateral approach for upper urinary tract tumors. It has the important advantages of low complications, small trauma and rapid postoperative recovery. It is especially suitable for patients with large surgical specimens.
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表 1 2组患者一般资料比较
例(%)，X±S 一般资料 Veress气腹针组(51例) 改良Hasson组(62例) P值 年龄/岁 51.2(14.7) 49.5(15.2) 0.21 性别 0.79 男 30(58.8) 38(53.0) 女 21(41.2) 24(47.0) 侧别 0.86 右侧 28(42.7) 35(42.2) 左侧 23(57.3) 27(57.8) BMI/(kg/m2) 23.51±3.79 24.12±4.37 0.36 手术类别 0.98 腹腔镜肾上腺肿瘤切除术 15(29.4) 17(27.4) 腹腔镜肾癌根治性切除术 17(33.3) 22(35.5) 腹腔镜肾部分切除术 13(25.5) 15(24.2) 腹腔镜肾输尿管根治性切除术 6(11.8) 8(12.9) 标本大小/mm 8.83±4.30 9.40±4.07 0.45 
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表 2 2组患者临床结果比较
例(%)，X±S 指标 Veress气腹针组(51例) 改良Hasson组(62例) P值 第一套管建立时间/s 79.1±21.9 82.8±27.3 0.39 CO2泄漏 1(2.0) 5(8.1) 0.22 出血量/mL 1.52±.0.37 1.67±0.41 0.28 血管损伤 1(2.0) 0 0.45 肠道损伤 0 0 皮下气肿 1(2.0) 1(1.6) 1.00 离断肌肉 46(90.2) 0 < 0.01 VAS评分/分 2.88±1.14 2.01±1.06 0.03 术后住院时间/d 5.6±0.8 4.0±0.6 0.01 肺部感染 0 0 下肢静脉血栓 1(2.0) 0 0.45
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