微创医学

目的介绍腹腔镜辅助胃(大肠)癌切除术中兼具切口保护和封闭功能的三种自制切口保护器的应用,以预防肿瘤细胞医源性扩散、切口种植,并便于标本切除后重建气腹腔镜下的后续观察操作。方法按手术顺序,将施行腹腔镜辅助胃癌、大肠癌手术的325例患者随机分成试验A、B、C组及对照组。试验A、B及C各组分别使用以红色F16单腔尿管与一次性医用无菌保护套、F24硅胶管与一次性医用无菌保护套及深静脉穿刺导丝鞘与一次性医用无菌保护套制成之三种底圈不同的自制切口保护器A、B及C,对照组则使用普通塑料套,观察比较术中拖出带瘤标本时三种底圈不同的自制切口保护器和普通塑料套的脱出次数。结果术中拖出带瘤标本时,试验A、B及C各组分别使用自制切口保护器A、B及C的脱出率分别为40.5%、23.8%及7.4%,明显低于对照组使用普通塑料套的脱出率78.8%。除试验A、B两组之间的脱出率比较差异无统计学意义(P>0.005)外,其余各组之间的脱出率比较差异均有统计学意义(均P<0.005)。结论三种自制切口保护器制作简单、使用方便且取材容易、成本低,对腹腔镜辅助胃(大肠)癌切除术的无瘤技术及随时封闭切口以重建气腹、方便腔镜下观察操作有重要意义,且降低手术费用,其中以深静脉穿刺导丝鞘与一次性医用无菌保护套制成者为最佳,值得在临床推广应用。

】Objective To recommend application of three types of self-made incision protectors in the course of laparoscopic surgery for gastric cancer or colorectal cancer，which not only can definitely protect incisions in order to prevent and reduce tumor cells’ iatrogenic diffusion and incisions’ local implantation，but also can promptly and reliably seal them to reestablish pneumoperitoneum and finish following-up observation and handling more conveniently under laparoscope after specimen being excised． Methods 325 cases with gastric cancer or colorectal cancer that underwent laparoscope-assisted surgery were divided into experimental group A，B，C，and control group． When these patients’ abdominal wall-assisted small incisions had to been protected and sealed in the course of operations，the experimental group A，B，C used self-made incision protector A，B， and C，which were made of a F16 red single lumen catheter with a disposable sterile protective sleeve，a F16 silicone tube with a disposable sterile protective sleeve，and a guide wire sheath for deep venepuncture with a disposable sterile protective sleeve，respectively，but the control group only used an ordinary plastic sleeve． The prolapse frequencies of the three types of self-made incision protectors with different foundation rings and the ordinary plastic sleeve in the course of laparoscope-assisted surgery for the patients with gastric cancer or colorectal cancer were observed and compared when their specimens were dragged out through their incisions． Results In the course of the laparoscope-assisted surgery，when the patients’ specimens with tumors were dragged out through the three different types of self-made incision protectors and the ordinary plastic sleeves，the prolapse frequencies of the self-made incision protector A，B andthan 78． 8% of the ordinary plastic sleeves that control group used． Except the contrast difference of the prolapse frequencies between the experimental group A and B，the contrast differences of the prolapse frequencies among the rest groups had statistical significance( all P ＜ 0． 005) ． Conclusion The three types of self-made incision protectors are simple for us to make and convenient for us to use，their raw materials are cheap and easily gained． In the course of laparoscope-assisted surgery for gastric cancer or colorectal cancer， they play an important role for us to perform tumor-free technique，to seal incisions promptly，to finish following-up observation，handle more conveniently under laparoscope after the specimens being exsected，as well as to cut down surgery cost． Therefore，they are worthy of popularization and application in clinical practice，and the best one among them is made of a guide wire sheath for deep venepuncture with a disposable sterile protective sleeve． C that the experimental group A，B and C used were 40． 5%，23． 8%，and 7． 4%，respectively，obviously lower