| Objective:To investigate the feasibility and safety of suction cup suspension in laparoscopic upper abdominal surgery.Methods:1.Design and use medical silicone rubber material to prepare a suction cup hanger suitable for clinical application.2.Use the prepared negative pressure suction cup hanger for in vitro test.Under the premise of ensuring safety,the best suction cup is obtained.3.Use the best specification of the sucker for animal test to verify the safety and feasibility of the sucker.4.The 20cases that met the standard were randomly divided into two groups for laparoscopic subtotal gastritis.The exposure field in the experimental group was negative pressure suction cup method,while the exposure field in the control group was suture suspension method,compare the two groups during the establishment of liver suspension time,exposure of the surgical field,total operation time,liver hematoma,tear and other complications;postoperative liver function and so on.Results:1.The in vitro test showed that the circular suction cup had a good adsorption force.According to the maximum suction force and the longest adsorption time of the suction cup,the better specification was selected as 8cm~2,circular,1cm high,0.2cm wall thickness.2.Laparoscopic liver suspension was successfully performed on pigs with negative pressure suction cup method,and the exposure effect of the operative field was good.The exposure time of the operative field was 144.17±25.73s,and the suspension duration was all greater than 120min,with no obvious complications.3.Twenty cases of laparoscopic subtotal gastrectomy were successfully completed,none of which were transferred to open operation.There was no significant difference between the experimental group and the control group in age,preoperative Body Mass index(BMI),preoperative Alanine transaminase(ALT)and Aspartate transaminase(AST).Intraoperative liver suspension time was 166.7±21.29s in the experimental group and 255.2±30.87s in the control group(t=-7.463,P<0.05),the suspension establishment time of the experimental group was lower than that of the control group,and the difference was statistically significant.The total operation time was 221.6±24.33min in the experimental group and 222.9±22.97min in the control group(t=-0.123,P=0.904),with no statistically significant difference.The surgical field score was 4.30±0.84in the experimental group and 4.00±0.67 in the control group(t=1.152,P=0.264),The difference was not statistically significant.The intraoperative blood loss was 34.30±9.65ml in the experimental group and 33.20±8.59ml in the control group(t=0.269,P=0.791),The difference was not statistically significant.No obvious complications occurred in the experimental group and the control group.On the first day after surgery,ALT was 37.97±7.62U/L in the experimental group and 50.36±10.72U/L in the control group(t=-2.981,P=0.008).On the first day after surgery,AST was 41.24±9.77u/L in the experimental group and 50.66±8.28u/L in the control group(t=-2.326,P=0.032),On the 3rd day after the operation,ALT was 34.39±6.51U/L in the experimental group and 43.60±10.63U/L in the control group(t=-2.337,P=0.031).On the 3rd day after surgery,AST was 34.89±6.44U/L in the experimental group and 42.61±7.82U/L in the control group(t=-2.411,P=0.027).On the 5th day after the operation,ALT was 28.00±8.59u/L in the experimental group and 30.40±15.57u/L in the control group(t=-0.427,P=0.675).On the 5th day after surgery,AST was 28.98±7.78u/L in the experimental group and 31.80±11.52u/L in the control group(t=-0.641,P=0.529).1 week after the operation,ALT was 24.35±7.78u/L in the experimental group and 24.69±10.67u/L in the control group(t=-0.081,P=0.936).1 week after the operation,AST was 22.07±6.30U/L in the experimental group and 25.83±7.93U/L in the control group(t=-1.174,P=0.256).The ALT and AST levels of the experimental group on the 1st and 3rd postoperative days were lower than those of the control group,and there was a statistical difference,while the two groups were on the 5th day and 1 week after the operation No statistical difference.Conclusion:When performing laparoscopic upper abdominal surgery,it is safe and feasible to suspend the liver to reveal the gastroesophageal junction with a negative-pressure suction cup hanger.It is simple and easy to operate,and shortens the operation time,improves the field exposure effect,and reduces abdominal wall puncture injuries.The advantages have the value of further promotion. |
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