有效、简便、易行的腹腔镜胆囊腹腔镜手术的简易程序
Effective, simple, easy procedure for laparoscopic port closure in difficult cases
Highlights
亮点
•The complete fascial closure of port site is essential for good outcome of laparoscopic surgery.
• Port site herniation is serious complication leading to loss all mini-invasive surgery advantages.
•Our technique is done under direct visualization and trocar sheath in its position.
•Our procedure is effective, easy to produce complete fascial closure at any port site type and in any case.
•端口点完整筋膜封闭腹腔镜手术效果好是必不可少的。
•椎间盘突出症是严重的并发症，导致丧失所有微创手术的优势。
•我们的技术是直接可视化及套管针鞘的位置。
•我们的方法是有效的，容易在任何端口的类型和在任何情况下进行完整的筋膜缝合。
Abstract
摘要
Background
背景
Laparoscopic and rebotic surgery is widely practiced in modern medicine. The operative procedure is not complete until the port sites are closed with a fascial closure. Good fascial closure still represents problem, especially in difficult obese patients. This study reported simple technique is suitable in such cases.
腹腔镜和机器人手术是现代医学的广泛应用。手术过程是不完整的,直到端口用筋膜关闭。好的筋膜关闭仍然是问题，特别是在困难的肥胖患者。本研究报告简单的技术是适用于在这种情况下。
Material and methods
材料与方法
We herein describe a simple technique for fascial closure after Laparoscopic surgery using percutaneous transabdominal approach by using two looped needles in 87 obese patients. This technique was done while the trocar sheath in its position.
本文描述了一个简单的筋膜封闭技术经皮经腹入路腹腔镜手术后的87例肥胖患者使用两环针。该技术是在其位置的外套。
Results
结果
The procedure was used in 87 patients (69 females and 18 males) after laparoscopic cholecystectomy with mean body mass index 35.5 kg/m2 and mean age 47.1 years from May 2013 through June 2015. No intra-operative incidents and no port sites hernias were reported during a mean follow up of 18 months.
该过程中使用的87例（69名女性和18名男性）腹腔镜胆囊切除术后平均体重指数为35.5公斤/平方米，平均年龄47.1岁，从2013年5月至2015年六月。没有手术的事件，没有端口疝报道在平均随访18个月。
Conclusion
结论
The procedure is easy to perform, safe, and effective for fascial port site closure in difficult obese (thick abdominal wall and oblique port wound) cases.
该法操作简便、安全、有效的端口关闭筋膜在肥胖者是困难的（厚腹壁斜口伤口） 病例。
原文：http://www.dxye.com/thread-24295-1-1.html
本帖最后由 小针刀 于 2016-9-27 09:34 编辑
Fig. 1. Looped needle formed of Long needle (20 cm outer sheath) and metal stent (25 cm put inside the outer sheath needle) has large loop (plastic wire). The metal stent can be pushed or withdraw through the outer sheath needle to put the loop outside or inside the needle tip. On right, the metal stent removed from outer sheath needle. On left, the metal stent put inside the outer sheath needle.图1.形成环形针长针（20厘米外护套）和金属支架（25厘米把外套针内）大环（塑料线）。金属支架可以通过外鞘针推动或退出，把环放在针尖外或内。右，从外鞘针取出的金属支架。在左边，金属支架放在外鞘针内。
Fig. 2. A: After of finish of laparoscopic procedure and the trocar sheath is in its position. The one looped needle holed the thread and passed at one side of port to appear at the peritoneal cavity.
Fig. 2B: The other looped needle passed on the other side of port to appear from peritoneal cavity. The two looped needles were directed to put other thread end inside the loop of second needle and its stent was withdraw to hold the thread end inside the needle.
Fig. 2C: Each thread end is holed by one looped needle.
Fig. 2D: The two looped needles and thread (Vicryl No. 0) ends inside them were withdraw until the needles ends reached at the subcutaneous plane of abdominal wall. Fig. 2E: The trocar sheath at this point was removed and the plane of two needles made more horizontal with abdominal wall. Then, the two needles were pushed to appear their ends and both thread ends from the port wound.
Fig. 2F: The both thread ends (Vicryl No. 0) were holed by tissue forceps and the looped needles removed by withdraw backward.
Fig. 2G: The two looped needles were removed and both thread ends holed by tissue forceps outside the port wound.
Fig. 2H: The suture strands were tied through the port site to produce good fascial closure, then closed the skin incision.
图2. A：后腹腔镜手术完成和外套在它的位置。一个环形针孔螺纹通过端口一侧出现在腹膜腔。
图. 2B：另用针通过对端口的另一边，从腹腔出现。两环针直接把其他的线程内结束第二针及其支架环退出持有的螺纹端针内。
图. 2C：每个螺纹端出一环形针。
图. 2D：两环针和线（可吸收0号）内结束他们被撤回到针端在腹壁皮下平面达到。
图. 2E：在这一点上，外套被两针与腹壁水平平面。然后，两针被推到出现他们的两端，这两个线程结束从端口伤口。
图. 2F: 两线头（Vicryl No. 0）是把组织钳和环形针被撤销后。
图. 2G：两环针和线头清除出组织钳口岸外的伤口。
图. 2H：缝合线绑端口通过网站产生良好的筋膜关闭，然后关闭皮肤切口。
Fig. 3. a: The two looped needles were directed under direct vision to put the thread end from one needle to other needle, then the stent and loop withdraw to hole the thread end inside the needle.
Fig. 3b: The thread ends were holed by two looped needles and withdraw until the needles tips reach at the subcutaneous plane of abdominal wall.
Fig. 3c: At this point, the trocar sheath is removed and two needles end with thread ends bring to port wound.
图. 3. a: 两环针引导直视下把线头从针等针，然后支架环退出孔的螺纹端针内。
图3b：螺纹端出两环针和撤回至腹壁皮下平面达到针尖。
图3C：在这一点上，套管针鞘被两针端螺纹端给港口的伤口。
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