CAJ | 학술논문

目的探讨经脐软式内镜完成腹腔粘连松解术的可行性和安全性.方法对1例因子宫肌瘤子宫切除术后腹腔粘连腹痛入院患者,经脐开口(1.5 cm)入腹腔,置入普通胃镜,经内镜送气系统送入CO2建立气腹.探查腹腔,见下腹正中刀口处腹膜与肠管和大网膜粘连,下腹部粘连较重.经内镜活检通道,分别用IT刀和Hook刀贴腹壁至上而下分离粘连带.分离大部分粘连后,发现分离过的大网膜和肠管粘连创面有新鲜渗血,内镜寻找出血点困难.遂经左下腹部布置1个5 mm鞘管,腹腔镜协助寻找出血点,但未见出血部位,后自行止血.腹腔镜协助完成残余粘连松解.脐部切口用可吸收线缝合l针,左下腹部小切口不缝合.结果手术过程耗时40 min,术中少量出血.患者术后脐部切口微痛,无需处理.术后当天进食并下床活动,观察2d无异常出院.结论经脐软式内镜腹腔粘连松解术是安全可行的,但有效性还有待进一步证实.
목적 탐토경제연식내경완성복강점련송해술적가행성화안전성.방법 대1례인자궁기류자궁절제술후복강점련복통입원환자,경제개구(1.5 cm)입복강,치입보통위경,경내경송기계통송입CO2건립기복.탐사복강,견하복정중도구처복막여장관화대망막점련,하복부점련교중.경내경활검통도,분별용IT도화Hook도첩복벽지상이하분리점련대.분리대부분점련후,발현분리과적대망막화장관점련창면유신선삼혈,내경심조출혈점곤난.수경좌하복부포치1개5 mm초관,복강경협조심조출혈점,단미견출혈부위,후자행지혈.복강경협조완성잔여점련송해.제부절구용가흡수선봉합l침,좌하복부소절구불봉합.결과 수술과정모시40 min,술중소량출혈.환자술후제부절구미통,무수처리.술후당천진식병하상활동,관찰2d무이상출원.결론 경제연식내경복강점련송해술시안전가행적,단유효성환유대진일보증실.
Objective To evaluate the feasibility and safety of trans-umbilical NOTES to perform abdominal adhesion lysis using a flexible endoscope.Methods A 42-year-old female was admitted to our hospital with a complain of abdominal pain due to abdominal adhesion after hysterectomy.A gastroscope (GIF-2TQ260M,Olympus)was inserted into the peritoneal cavity through an incision(1.5 cm)of the umbilical opening.Pneumoperitoneum was established by the endoscopic air supply system using CO2 instead of air.Abdominal exploration showed that omentum and bowel were stuck to the scar of the low central peritoneum incision.Separation of the abdominal wall adhesions was performed with an IT knife and a hook knife respectively.After most of the adhesions were separated,bleeding was found from the isolated adhesion wound of the omentum and bowel.Hemorrhaged blood vessel was difficult to be found with the flexible gastroscope.Then a 5 mm Trocar was placed at the left lower abdomen and laparoscopic assistance was adopted to search the bleeding point.However,no bleeding site was found and the hemorrhage was stopped automatically.Residual adhesion lysis was conducted with laparoscopic assist.After the procedure,the umbilical incision was closed with absorbable suture,but lower left abdominal incision was left without suturing.Results The operation time was 40 minutes.The patient suffered from minus pain from the umbilical incision without need of treatment.She had normal diet and got out of bed after reconsious.She was discharged 2 days after the procedure without any complaints.Conclusion Trans-umbilical NOTES using a flexible endoscope for peritoneal adhesion lysis is safe and feasible,but the effectiveness remains to be further confirmed.