Left upper quadrant approach in gynecologic laparoscopic surgery
Left upper quadrant approach in gynecologic laparoscopic surgery
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DOI：
10.1111/j.1600-0412.2011.01257.x
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发表时间：
2011-12-01
影响因子：
4.3
通讯作者：
Pun, Ting-Chung
中科院分区：
文献类型：
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作者：
Ngu, Siew-Fei;Cheung, Vincent Y. T.;Pun, Ting-Chung
目标。回顾九年来左上象限入路在妇科腹腔镜良性手术中的应用。设计。回顾性研究。设置。大学附属医院。人口。在2002年1月至2010年12月期间接受腹腔镜妇科手术的女性。方法。审查了医疗记录。主要结果测量。人口统计资料，既往手术史，手术指征和左上象限入路的使用，术中发现，诊断和任何并发症。结果：共发现143例，占全部妇科腹腔镜手术的4.9%。采用左上象限入路的指征为：既往开腹手术（113例，79.0%）、妊娠中期手术（16例，11.1%）、存在大盆腔肿块（9例，6.2%）、既往行腹直肌横切肌皮瓣乳房重建（3例，2.0%）、既往行脐周疝修补术（1例，0.6%）、既往腹腔镜下脐部创面裂开（1例，0.6%）。在既往腹部手术的女性中，网膜和/或肠与脐区前腹壁之间粘连的总发生率为58.4%。12例（8.3%）患者需要转为剖腹手术。1例患者在左上腹入腔处有皮下手术肺气肿。结论。左侧上象限入路是腹腔镜妇科手术女性进入腹腔的一种有效、安全、简便的技术，对于有脐周粘连危险因素和存在大盆腔肿块的女性应予以考虑。
Objective. To review the use of the left upper quadrant approach in benign gynecologic laparoscopic surgery over a nine-year period. Design. Retrospective review. Setting. University-affiliated hospital. Population. Women who underwent laparoscopic gynecologic surgery the upper quadrant approach between January 2002 and December 2010. Methods. Medical records were reviewed. Main outcome measures. Demographic data, past surgical histories, indications for surgery and the use of the left upper quadrant approach, intraoperative findings, diagnosis and any complications. Results. 143 patients were identified, accounting for 4.9% of all gynecologic laparoscopic surgery. The indications for using the left upper quadrant approach were: previous open abdominal surgery (113, 79.0%), surgery in the second trimester of pregnancy (16, 11.1%), presence of large pelvic mass (9, 6.2%), previous transverse rectus abdominis myocutaneous flap for breast reconstruction (3, 2.0%), previous periumbilical hernia repair (1, 0.6%) and previous laparoscopic umbilical wound dehiscence (1, 0.6%). In women with previous abdominal surgery, the overall incidence of adhesions between omentum and/or bowel to the anterior abdominal wall in the umbilical region was 58.4%. Twelve (8.3%) patients required conversion to laparotomy. One patient had subcutaneous surgical emphysema over the left upper quadrant entry site. Conclusions. The left upper quadrant approach is an effective, safe and easy technique for peritoneal cavity access in women undergoing laparoscopic gynecologic surgery and should be considered in women with risk factors of periumbilical adhesions and in the presence of a large pelvic mass.