脐孔腔镜阑尾切除术研究进展
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摘要 目的 介绍脐孔腔镜阑尾切除术的科学性、实用性、先进性及微创美容价值。方法采用文献综述的方法。结果 外科学者从盲肠活动度，麦、脐距离测定，预测并实现了盲肠阑尾拉出脐外手术达到了微创美容的目的。通过肚脐的测量，创制了不同型号的脐刀―周氏脐刀，脐镜鞘气囊“碘伏(洗必肽)棉球浸渍换药法”的发明，加快了手术速度，保障了术后肚脐不感染。结论 脐孔腔镜阑尾切除术是完美的微创、美容、科学的结晶，利在人类，启迪来者。
关键词：阑尾炎 肚脐测量 盲肠活动度与麦―脐距离测量 脐孔腔镜阑尾切除术 周氏压痛点 周氏脐刀 脐镜鞘气囊 碘伏棉球浸渍换药法
脐孔腔镜阑尾切除术是通过脐入路，用腹腔镜探查，并拉盲肠，阑尾于脐外手术切除，理想包埋阑尾残端，妥善修复肚脐[1]，用可吸收线(3月吸收)缝合至真皮(不缝表皮)，因此，在腹部不见刀口，亦不见针眼。刀口隐藏于脐内右侧壁，做到极度“美容”微创。
实现这种手术成果，源于盲肠活动度[2]，麦―腔距离测量[3]，肚脐测量[4]，周氏脐刀[4-5]，脐镜鞘气囊[6]，“碘伏(洗必肽)棉球浸渍换药法”[1]的发明，腹腔操作镜的改制，手术方法、手术程序及手术适应症及禁忌症的制订[7、8、9]，麻醉特殊要求[12]，术前、术中[11]、术后的护理[11]等研究。
1.盲肠活动度
1.1盲肠活动度的观察测量，早在80年代，四川省南充市中心医院普外科在做乙状结肠及左下腹手术时，经常发现阑尾、盲肠出现在左下腹。传统阑尾切除术，也是拉阑尾、盲肠于腹外完成切除及包埋的。90年代，腹腔镜的广泛使用，他们开始了盲肠活动度的探索、测量[2-3]，他们在《正常人体群剖字》1961年版第140页查见：“盲肠长约6-8厘米，大部被腹膜覆盖，因此可以移动。”又在解剖学测量及千余例普外手术中，发现成人盲肠活动度在10-12cm以上[3]，小儿盲肠活动度更大。
1.2麦氏点至肚脐的距离[3]。为了了解盲肠起端至肚脐的距离，外科医师们认为：麦氏点、盲肠端、脐中心点，三点构成一直角三角形。在一般情况下，腹壁是贴合在肠道上的，他们把这个距离设定为1cm，麦氏点、盲肠起端、脐中心点，构成一直角三角形。如麦氏点至盲肠起始端为“勾”，那么，麦氏点至脐中心应为“股”，盲肠起始端至脐中心点，应是“弦”，根据勾、股、弦定律。勾(1)2×股2=弦2，因此，麦氏点至脐中心的距离(股)与盲肠至脐中心点的距离(弦)是相近的。故，测量麦―脐距离，就如同测量了盲―脐距离[3]，测量325例成人，521例儿童，成人该距离为8-9cm，Mj=5.68778+0.01041age+0.08153weigh cm (F=52.29P＜0.0001),(性别和身高没有统计学意义)。儿童为Mj=42.79-2.90sex+1.77weighmm，sex为性别，男=0，女=1，weigh是体重。是故，确证盲肠阑尾可以拉至肚脐(手术)。
2.肚脐解剖及脐刀：
2.1肚脐解剖[4-5]，肚脐是一圈形凹坑，表层为脐残端皮化之皮皱，深层是皮下脂肪及纤维结缔组织，有时有脐静脉网乃至腹腔静脉；再深层为腹白线圈形固定圈，再深层为脐动静脉或其残管；再深层为腹膜。白线两侧与腹直肌鞘连续。无环形肌。因此，无论在鼓腹及松腹时，肚脐的形状、大小不变。为此，专家们用橡皮泥在肚脐内塑形，再用分规及标准硬尺测量塑形相应部位，则测出脐深及脐口、脐底各径[4-5][13]。
2.2周氏脐刀Zhou’s Umbilicus Lancet；专家以肚脐脐口各径[4-5]为依据，制造相应型号之脐刀[4]，并命名为“周氏脐刀”[1][4][6]，使切开脐内右侧皮肤快了800至2000倍。
3.腹腔操作镜的使用及其改进。
3.1时至今天，腹腔镜的应用已经普及。但使用腹腔操作镜做手术，尤其是科学、准确、完美、成功、快速的，用操作镜拉盲肠、阑尾至脐外手术，并完成理想包埋，这种手术，即“脐孔腔镜阑尾切除术”Peritoneoscopic Appendectomy through the Umbilicus还很少。
该手术切口隐于脐内右侧壁[1]，引进5/8圆的(三月吸收的)带线针[1]修复腹白线及真皮，术后看不到刀口及针眼，这的确是完美、创造性的使用了腹腔镜。
3.2腹腔操作镜的改进。国外的操作镜，镜身长36cm，要求使用45cm的抓钳，分离钳及冲洗吸引管。在施行手术中，操作不方便，还容易碰上术者身后的监视器及其支架。为此，作者请上海金宝隆腹腔镜研究所特制了24cm长之操作镜―阑尾操作镜。该镜于2005年10月11日投入使用，配合常规的33cm抓钳、冲吸管，操作甚是方便。
4. 关于trocar及Trocar气囊。
4.1 Trocar，国内翻译为“穿刺鞘”、“气腹针鞘”。这不适用于我们和香港腹腔镜手术第一个孔的层层切开入腹置入之trocar。在“脐孔腔镜阑尾切除术”中，我们译trocar为“腹腔操作镜鞘”，简称“脐镜鞘”。
为方便拉盲肠、阑尾出脐外手术，脐内弧形切口要求10-14cm，故不能使用气腹针。
4.2脐镜鞘气囊，Trocar Umbilicus Balloon
只要真正做脐孔腹腔阑尾切除术，就知道，脐侧皮松弛，切割慢，要用脐刀[1][4][6]。置入脐镜鞘，建立气囊后，再做手术时，常因“鞘”周漏气，而反复重建气腹，费时费力，手术台上台下均感气馁，专家为此，发明了“脐镜鞘气囊”[1][6]，有效防止了术中漏气，大大缩短了手术时间。
5.脐入路手术的 “脐疝”预防。
5.1修复。肚脐内切口分层修复，腹膜、腹白线、真皮、皮下(该两层缝在一起，并与腹白线固定，以便成凹坑形)。修复腹白线用5/8圆(曲度)带线针，该线牢固，不滑脱，5/8曲度好转弯，好使用，该线三个月后可吸收。
5.2预防脐切口感染。由于肚脐是藏于污垢之所，故术者，发明了“碘伏(洗必肽) 棉球浸渍换药法”Chemicaly-Soaked dressing，使术后肚脐持续浸渍[1]，造成无菌状态，保障肚脐不感染，有效的进一步预防了“脐疝”的发生。
洗必肽，是对碘伏过敏者用。
6.手术适应症：“脐孔腔镜阑切除术”是有适应症的。
6.1阑尾炎病人在左侧卧位时，压痛点移位至脐右或脐下1-3cm，说明盲肠活动，很适合做脐孔腔镜阑尾切除术。作者把阑尾炎病人左侧卧位之压痛点叫作“周氏压痛点”Zhou’s tenderness Poit[8-9]，凡是周氏压痛点近脐者，说明盲肠活动适合做脐孔腔镜阑尾切除术，如周氏压痛点与麦氏点重合，就说明盲肠不活动，有炎性挛缩、粘连，不适合做该手术。故“周氏压痛点近脐”，是脐孔腔镜阑尾切除术的适应症。
“周氏压痛点”是阑尾炎的第三个压痛点。
6.2病程短，在72h以内，无粘连，或粘连轻[1]，仍可在术中左侧卧45°，头低脚高15°之手术台上，轻易分离粘连，完成手术。
6.3盆位阑尾炎，阑尾长，容易用抓钳拉出手术。
6.4阑尾穿孔，腹腔炎。大凡阑尾发炎，炎症灶主要在阑尾炎端或体部，阑尾根部炎症较轻，故抓钳可抓住阑尾根部拉出脐孔手术。腹腔脓液可用“冲吸管”冲入甲硝唑液，冲洗吸引，确保干净后，结束手术。
7.禁忌症：
7.1病程长，粘连重者；
7.2盲肠壁内阑尾炎[1]，其周氏压痛点与麦氏点重合。
7.3盲肠后位阑尾炎，腰大肌试验阳性。
7.4合并盲肠肿瘤、结核、溃疡性结肠炎、伤寒等疾病。
7.5心、肺功能不全，二氧化碳滞留，不宜做气腹的病人。
8.脐孔腔镜阑尾切除术的麻醉[10]。
8.1全麻，腹部松弛，脐内右侧切口入腹易，而且在小小的脐内切口，能清楚发现脐静脉网，腹脐静脉，以及腹白线后的脐动、静脉，以便止血。
8.2腹部松弛的全麻，脐镜鞘入腹，不易损伤内脏；
8.3需要全麻。建立气腹后，常规置病人于头低脚高15°。左侧卧位45°，方便暴露阑尾及盲肠。也方便分离轻度之粘连，这是需要腹部松弛的全麻。
9.术中护理配合[11]
9.1术中固定，要求左髋置“托”，膝上压带，当病人建气腹后，摆时，不滑落。
9.2术中建气腹后，常规置头低脚高15°左侧卧位45°，我们把这叫做“脐镜阑尾切除位”。
9.3凡是阑尾化脓，或穿孔腹膜炎病人，必须连接冲洗吸引管及甲硝唑液备用。
9.4使用“脐孔腔镜阑尾切除手术包”，除常规器械外，还有特殊“腹壁拉钩”，5/8爱惜康带线针、周氏脐刀、脐镜鞘气囊、消毒脐切口的碘伏棉球、灭菌的石碳酸、酒精、生理盐水、24cm操作镜――阑尾操作镜、33 cm抓钳、分离钳、冲洗吸引管等。
9.5控制监视器。在术者使用国外36cm操作镜、45cm抓钳时，要后移监视器并稳定之，以防插钳入镜时，碰上或碰倒监视器。
10.术前术后护理[12]
10.1谢敏等提出，术前应去除肚脐油垢，脐周去毛、腔内、脐周消毒。
10.2术前2h用抗生素，降低感染，防止感染扩散。
10.3术后保持肚脐碘伏棉球之碘伏饱和，持续浸渍，三至七天，确保无菌状态预防感染，杜绝脐疝发生。
脐孔腔镜阑尾切除术已完成近千例。该研究有扎实的基础研究，有发现、有发明、有操作镜的创新改进；有脐入路手术防止脐疝发生的周密预防措施；科学的手术方法，严密的手术程序；对麻醉有明确要求，以及术中及术前、术后的护理配合，显示了该手术的严谨、科学、先进、成熟、适用，而且易于推广。微创、美容极至。既造福于患者，也能启迪同道。妇科、腹腔定位放、化疗乃至普外其他手术都可选脐入路。
参考文献
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2.《正常人体解剖学》[M]，人民卫生出版社1961[J]年版
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5.周家镇、王德荣、谢敏等，国人，成人肚脐测量[J]，中华医学实践杂志，2006.5(1)
6.周家镇、任明杨、王德荣等，周氏脐刀、脐镜鞘气囊403例脐孔腔镜阑尾切除术应用报告[J]中华医药杂志20055（12）：1259
7.郭黎、蒲敏、黄卫等：阑尾炎诊断与治疗的进展[J]西部医学200416(4) 369
8.周家镇、王德荣、任明扬等：“周氏点”对脐孔腔镜阑尾切除术的应用报告[J] 西部医学(J)200517(2):116
9.魏成刚、周家镇、夏全等：“周氏压痛点”403例脐孔腔镜阑尾切除术预测报告[J]中华医学实践杂志(J)20054(11)： 1176
10.张晓华、王静：脐孔腔镜阑尾切除术术中配合[J]实用医院临床杂志20063 (1)：99
11.谢敏、蒋纯、唐雪梅等：脐孔腔镜阑尾切除术前术后护理[J] 华西医学(J)200621(1)：
12.夏全、岳济民等：脐孔腔镜阑尾切除术的麻醉要求[J]中华现代外科学杂志2006：
13.周家镇、王德荣、夏全等：521例肚脐测量报告[J]中华实用医学杂志2006 6(20)：2261
The peritoneoscopic appendectomy through the umbilicus is an operational procedure, which is performed through the umbilicus with the help of the peritoneoscopic exploration to pull the cecum and appendix out of the umbilicus and perform the removal of the diseased appendix. With this approach, the residual end of the appendix can be desirably embedded and the umbilicus can be cosmetologically restored.[1] The absorbable sutures can be used to the hypodermis with no need for the sutures of the epidermis. Thus, there are no incision and needle marks left on the abdomen because the incision is hidden in the right lateral wall in the umbilicus, with perfect minimally-invasive cosmetological features.
This kind of perfect operation is attributed to the inventions of Zhou’s Umbilicus Lancet; [4, 5] Trocar Umbilicus Balloon,[6] and the Chemicaly-Soaked Dressing in entizol solution, which were based on the determinations of the cecum activity and the distance between the McBurney's point and the umbilicus. It is also attributed to the following improvements on the peritoneoscope, operational approaches and procedures, definitions for operational indications and contraindications,[7-9] specific requirements for anesthesia,[12] and the nursing before operation, during operation,[11] and after operation.[11]
1. The activity of the cecum
1.1 Observation and determination of the activity of the cecum.In the early 1980’s, the surgeons at the Nanchong Municipal Central Hospital of Sichuan Province occasionally found that the cecum and appendix were located in the patient’s left lower abdomen when they performed sigmoidoscopy or operation on the patient’s left lower abdomen. The conventional appendectomy was performed by pulling the cecum and appendix out of the abdomen so as to remove the diseased appendix and to embed the residual end of the appendix.In the 1990’s, with the wide spread use of the peritoneoscope, these surgeons began to explore and determine the activity of the cecum.[2, 3] They read in Normal Human Anatomy (1961 ed., p.140) that the cecum is about 6-8 cm in length and is mostly covered with the peritoneum; therefore, it is capable of movements. Based on the anatomical determination and thousands of operations, these surgeons found that the activity of the cecum in the adults was in the range of 10-12 cm;[3] and the activity in the children was more than that range.
1.2The distance between the McBurney's point and the umbilicus.[3]In the calculation of the distance between the starting point of the cecum and the umbilicus, the surgeons generally have an idea that the McBurney's point, the starting point of the cecum, and the central point of the umbilicus form a right triangle. In general, Theabdomen wall is attached to the intestine, and therefore their distance is supposed as 1 cm. If the distance between the starting point of the cecum and the umbilicus is regarded as the shorter leg of the right triangle, then the distance between the McBurney's point and the central point of the umbilicus becomes the longer leg of the right triangle and the distance between the starting point of the cecum, and the central point of the umbilicus becomes the hypotenuse. According to the Pythagorean theorem, the shorter leg (1)2 × the longer leg 2 = the hypotenuse 2 . Therefore, the distance between the McBurney's point and the central point of the umbilicus (the longer leg of the right triangle) is almost the same to the distance between the starting point of the cecum, and the central point of the umbilicus (the hypotenuse). The determination of the distance between the McBurney's point and the central point of the umbilicus is equal to the determination of the distance (Mj ) between the starting point of the cecum, and the central point of the umbilicus.[3]The surgeons measured the distance in 325 adults and 521 children and found that the distance in the adults was 8-9 cm,Mj = 5.68778 + 0.01041 age + 0.08153 weight (cm), F = 52.29P ＜ 0.0001. There was no statistical significance in the sex or height. In the children, Mj = 42.79-2.90 sex + 1.77 weight(mm)， male = 0，female = 1. Therefore，they confirmed that the cecum and appendix could be pulled out of the umbilicus during operation.
2.Anatomy of the umbilicus and Zhou’s Umbilicus Lancet
2.1Anatomy of the umbilicus.[4, 5]The umbilicus is shaped like a round concave pit. The umbilicus appears in a form of creases of the skinned stump of the umbilical cord. Under the surface comes a layer composed of the subcutaneous adipose tissue and the fibrous connective tissue. Sometimes the networks of the umbilical vein and the para-umbilical vein are also observed. And next comes the circle-shaped linea alba, umbilical blood vessels, and residual vessels. The most inner layer is the peritoneum. The vagina musculi recti abvdominis is connected on the right and left sides, without any circular muscles. Therefore, the umbilicus does not change in shape or size when the abdomen is expanded or restricted. In this research, the surgeons used plasticence to mold the umbilicus shape, and then measured the depth and the outer and inner diameters of the corresponding molded parts of the umbilicus with the divider and the ruler. [4, 5, 13]
2.2Zhou’s Umbilicus Lancet.Based on the corresponding diameters of the umbilicus, [4,5] the researchers designed the umbilicus lancets of different kinds. This kind of umbilicus lancets are named Zhou’s Umbilicus Lancet (Figure 1).[1,4, 6]This lancet has increased the incision speed by 800-2000 times when used to incise the right lateral skin in the umbilicus.
3.Operating and improving the peritoneoscope
3.1Application of the peritoneoscope.So far the peritoneoscope has widely been used in clinical practice, but the peritoneoscopic appendectomy through the umbilicus has rarely been seen. This kind of appendectomy can achieve a more scientific, accurate, desirable, successful, and rapid operative result because this kind of appendectomy can pull the cecum and appendix out of the umbilicus so as to accomplish an ideal removal of the diseased appendix and the embedding of the residual appendix.
The incision of the appendectomy was hidden in the right lateral wall of the umbilicus, [1] and a 5/8 curved needle with an absorbable suture thread was used to suture the linea alba and the hypodermis. There were no incision or needle marks left after operation. This appendectomy has more creatively and desirably used the peritoneoscope.
3.2Improvement of the peritoneoscopic manipulation.The peritoneoscope used in foreign countries is 36 cm in length, which requires a 45-cm-long clasper, a separating forceps, and a washing suction tube. This makes the operation difficult to perform. Thus, the surgeon in this research asked the Shanghai Jinbaolong Peritoneoscope Institute to make a special 24-cm-long peritoneoscope for appendectomy (Figure 2), which was used on October 11, 2005 in the Nanchong Municipal Central Hospital of Sichuan Province, with the help of the conventionally-used 33-cm-long clasper, and the washing suction tube. The operation was made much easier by the above equipment.
4. The trocar and the Trocar Umbilicus Balloon
4.1The trocar.The trocar, also called puncture sheath or pneumoperitoneum needle sheath, is not suitable for the peritoneoscopic appendectomy through the umbilicus. Therefore, the surgeons in the hospital have improved the trocar and the improved trocar is named Trocar Umbilicus Balloon.
For more convenience in pulling the cecum and appendix out of the umbilicus, the curved incision in the umbilicus should be 10-14 cm in length, so the pneumoperitoneum needle cannot be used.
4.2The Trocar Umbilicus Balloon.The previous peritoneoscopic appendectomy through the umbilicus has some problems. For example, when the umbilical skin is flaccid, which makes the cutting more difficult, the umbilicus lancet should be used, [1,4,6] and at this time the lancet should be placed in the trocar to form a balloon for an operation. However, the trocar will leak occasionally, which makes the operation not smooth; therefore, the pneumoperitoneum has to be established repeatedly, which is both time-consuming and energy-consuming.
To solve the problem, these surgeons have invented Trocar Umbilicus Balloon (Figure 3), [1, 6] which has solved the leaking problem and has shortened the time for the operation.
Fig.3Trocar Umbilicus Balloon for the peritoneoscopic appendectomy through the umbilicus.
5.Prevention against umbilical hernia caused by operation via the umbilicus
5.1Repairing and restoring procedures.The incisions in the umbilicus should be repaired and restored layer by layer. The hypodermis and the subcutaneous tissues should be sutured together and attached to the linea alba so as to form a concave-shaped pit; the linea alba should be repaired and restored by the 5/8 curved needle with an absorbable suture thread, and the suturing should be reliable and the thread can be absorbed after 3 months.
5.2Prevention against infection of the incision.As the umbilicus is a place for dirts hidden, these surgeons have invented Chemicaly-Soaked Dressing in rotersept solution, which can keep the umbilicus soaked with the dressing after operation, effectively preventing infection and avoiding umbilical hernia.
6.Indications for the peritoneoscopic appendectomy through the umbilicus
6.1When the appendicitis patient lies in the left lateral position and feels the tenderness shifting to the right side of the umbilicus or 1-3 cm under the umbilicus, this indicates the cecum is overactive and the patient is suitable for the peritoneoscopic appendectomy through the umbilicus. The author of this article has named this kind of tenderness point in the left lateral position as Zhou’s Tenderness Point or Zhou’s Point. [8, 9]Whoever has this kind of tenderness point in the left lateral position is suitable for the peritoneoscopic appendectomy through the umbilicus because the tenderness indicates an activity of the cecum. If Zhou’s Tenderness Point is overlapped with the McBurney's point, it indicates that the cecum is not overactive and infective spasms or adhesion may exist, and therefore the patient should not undergo the peritoneoscopic appendectomy through the umbilicus. So, the nearness of Zhou’s Tenderness Point to the umbilicus is an indication for the peritoneoscopic appendectomy through the umbilicus.
Zhou’s Tenderness Point is the third tenderness point to suggest appendicitis.
6.2The course of disease can be shortened within 72 hours, with no adhesion or mild, if any. The patient still can lie at 45°in the left lateral position, with 15°higher position of the feet than the position of the head on the operating table, which makes the adhesion separation easier so as to have an accomplishment of the operation.
6.3The clasper can easily pull the relatively-long appendix or the appendix in the case of appendicitis occurring in the pelvis out of the umbilicus for the operation.
6.4In the case of perforating appendicitis with peritonitis, the inflammation mainly occurs in the end or body of the appendix, and it is milder in the root part of the appendix; therefore, the clasper can relatively easily pull the root of the appendix out of the umbilicus. The pus accumulated in the abdominal cavity can be washed with entizol solution via the washing suction tube so as to keep a clean operating field.
7.Contraindications for the peritoneoscopic appendectomy through the umbilicus
7.1The course of disease is prolonged with serious adhesion.
7.2Appendicitis occurring in the wall of the cecum,[1] and Zhou’s Tenderness Point overlapping the McBurney's point.
7.3Appendicitis occurring behind the cecum, and the psoas test is positive.
7.4Appendicitis accompanied by tumor of the cecum, tuberculosis, ulcerative colonitis or typhoid fever.
7.5Appendicitis accompanied by cardiac and pulmonary dysfunction, retention of carbon dioxide, or the patient unsuitable for pneumoperitoneum.
8.Anesthesia for the peritoneoscopic appendectomy through the umbilicus.[10]
8.1Under general anesthesia, the abdomen becomes relaxed and the incision is easily made on the right lateral side of the umbilicus; and the small incision in the umbilicus makes it easy to observe the networks of the umbilical vein, the para-umbilical vein, the umbilical arteries and veins behind the linea alba so that stopping hemorrhage will become easier.
8.2Under general anesthesia, the abdomen becomes relaxed and Trocar Umbilicus Balloon can be inserted with ease, avoiding an injury to the internal organs.
8.3Under general anesthesia, after the inducing of general anesthesia and pneumoperitoneum, the patient is laid at 45°in the left lateral position, with 15°higher position of the feet than the position of the head on the operating table, which makes the adhesion separation easier so as to expose the appendix and cecum and to separate the mild adhesion.
9.Nursing during operation[11]
9.1The fixation is required, which can be achieved by the left hip on a support and the knee oppressed by a belt. When the patient has established pneumoperitoneum, the fixation can still be protected from shaking away during the change of the position.
9.2After the establishment of pneumoperitoneum, the patient is usually laid at 45°in the left lateral position, with 15°higher position of the feet than the position of the head. This position is called the position for the peritoneoscopic appendectomy through the umbilicus.
9.3For the patient with purulent appendicitis or perforating appendicitis, the washing suction tube should be attached and entizol solution should be prepared for use.
9.4The operational package for the peritoneoscopic appendectomy through the umbilicu should be prepared for use, including the routine surgical equipment and some special equipment as well, e.g., special retractor for the abdominal wall, 5/8 curved needle with a suture thread, Zhou’s Umbilicus Lancet, Trocar Umbilicus Balloon, chemically-soaked gauze rolls for sterilizing the umbilical incision, sterilizing carbolic acid, alcohol, normal saline, 24-cm-long peritoneoscope for appendectomy, 33-cm-long clasper, separating forceps, and washing suction tube.
9.5 The monitoring equipment should be protected from damaging. For example, when the 36-cm-long peritoneoscope for appendectomy and the 45-cm-long clasper are used, the monitoring equipment should be placed backwards and be stabilized for fear of being damaged.
10.Nursing before operation[12]
10.1All dirts in the umbilicus should be removed, hairs around the umbilicus should be shaved, and the interior of the cavity and the area around the umbilicus should be sterilized.
10.2Two hours before operation, antibiotics should be used to reduce the severity of infection and prevent the spread of the infection.
10.3Chemically-Soaked Dressing in entizol solution should be kept in use for 3-7 days after operation so as to prevent infection and umbilical hernia.
These surgeons have performed nearly 1000 peritoneoscopic appendectomies through the umbilicus. This research and its clinical application have been performed on a solid foundation and have consisted of discovery, invention, and improvement on the existing peritoneoscopic operations. They have developed preventive measures against the occurrence of umbilical hernia, scientific surgical approaches and procedures, strict requirements for anesthesia, and cooperated nursing cares before, during, and after operation. All these have indicated that this kind of operation is rigorous, scientific, advanced, mature and feasible in design and application, and it is easy to spread in clinical practice. The perfect minimally-invasive cosmetological features will benefit the patients and encourage the related medical professionals to adopt this kind of peritoneoscopic umbilical approach, e.g., in gynecological surgery, chemotherapy and radiotherapy in the abdominal cavity, and other surgical operations.
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2.Normal Human Anatomy [M].The People’s Medical Publishing House1961 ed.
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