摘要
腹腔镜应用于普通外科尤其是结直肠外科已成为临床常规操作,其疗效和安全性得到广泛认可。腹腔镜手术与开腹手术存在区别,前者有其独特点。在临床实践中,经常会发生腹腔镜操作中手术视野外其他脏器损伤的情况,包括空腔脏器如胃、十二指肠、小肠和结肠,也包括实质脏器如脾脏等。如果在术中发现手术视野外其他脏器损伤,就可及时采取相应的补救措施;而在术后发生,则往往难以与吻合口漏等并发症进行鉴别,处理相当棘手,严重影响患者的医疗安全,甚至导致医患纠纷。根据笔者的经验,在腹腔镜手术过程中,从置入Trocar开始就可能发生意外损伤,而在术中牵拉和游离时发生意外损伤最多,也有发生在器械进出Trocar的过程中。意外损伤的发生常常很隐蔽,但是通过轻柔仔细的操作、术中注意意外现象的发生、手术结束前全面观察腹腔等,可以有效避免意外损伤的发生,做到及时处理已经发生的意外损伤。稳定的手术团队、手术人员减少无关组织的抓持以及不让器械移至镜头外,可以极大地降低不可预料的腹腔镜手术视野外的意外损害。只有做到器械在手、敬畏在心,才能真正避免无谓的损伤。本文探讨了笔者在临床实践中预防和处置腹腔镜手术视野外意外损伤的经验,以期为结直肠外科医师提供参考和借鉴。
The application of laparoscopy in general surgery,especially in colorectal surgery,has been a routine clinical practice.Its safety and efficacy have been widely recognized.Different from open abdominal surgery,laparoscopic surgery has its unique characteristics.In clinical practice,other organs out of visual field are often injured during operation,including both empty organs such as stomach,duodenum,small intestine and colon,as well as parenchymal organs such as spleen.If it is found during the operation,corresponding remedial measures can be taken in time.If it occurs after the operation,it is difficult to be distinguished from other complications such as anastomotic leakage,and treatment is quite challenging,seriously affecting the medical safety of patients,and even leading to doctor-patient disputes.Based on the author’s experience,unexpected injuries may occur starting from the second of Trocar insertion,most of which occurred during intraoperative traction and detachment,or during the entry and exit of instruments into Trocar.The occurrence of accidental injury is often subtle,but through gentle and careful operation,attention to the occurrence of unexpected events during the surgery,and comprehensive observation of the abdominal cavity before the end of the surgery,it can be effectively avoided in a timely manner.A stable surgical team can greatly reduce the unexpected damage out of the field by reducing the grasping of irrelevant tissues and keeping the instruments away from the camera.Only with the instrument in the hand and the awe in the heart can we really avoid unnecessary damage.This article intends to discuss the author’s experience in preventing and treating accidental injury in the field of laparoscopic vision in clinical practice,in order to provide references for colorectal surgeons.
作者
刘鹏
楼征
张卫
LIU Peng;LOU Zheng;ZHANG Wei(Department of Anorectal Surgery,The First Affiliated Hospital of the Chinese People’s Liberation Army Naval Military Medical University,Shanghai 200433)
出处
《肿瘤》
CAS
北大核心
2023年第5期376-381,共6页
Tumor
基金
国家自然科学基金(82203356、82072750)
上海市自然科学基金(20ZR1457200)
2023年度上海市“科技创新行动计划”技术标准项目(23DZ2202000)
关键词
结直肠外科
腹腔镜手术
手术视野外的意外损害
处理
预防
Colorectal surgery
Laparoscopic surgery
Unexpected injuries out of the visual field
Management
Prevention
