Jain点腹腔镜入路Palmers点的禁忌证

进行这项研究是为了评估Jain点克服Palmers点禁忌症的功效。 Jain点于左腹 L4 水平，脐外侧 10-13cm 处。 由于其解剖学位置，Jain 点没有粘连，因为术后粘连通常发生在中线或右侧。

这是一项在高容量三级医疗转诊中心进行的高级妇科腹腔镜手术的回顾性研究，纳入了 2011 年 1 月至 2022 年 3 月在该中心接受腹腔镜手术的 8,586 名患者。在本文中，分析了 2,519 名既往有既往手术史的患者 使用Jain点进行手术的手术。

在有既往手术史的 2,519 名患者中，无论疤痕位置、既往手术的次数和类型，以及Palmers点禁忌症患者，均发现Jain点端口无粘连。 除了一例 (0.04%) 的小肠损伤外，没有报告重大并发症，该病例在术中进行了处理。 Jain 点继续作为主要的符合人体工程学的工作端口发挥作用。

Jain点为普通外科医生、泌尿科医生、肿瘤科医生和减重外科医生等不同专业的腹腔镜外科医生在以往的手术案例中提供了一个替代的安全入口，以克服Palmer点的禁忌症。 Jain点也是人体工程学的主要工作端口，而 Palmers点在初次进入后就变得多余了。

Jain点腹腔镜入路Palmers点的禁忌证

图 1
(A) Jain 点的表面标记，显示距脐和左下端口的距离。 患者在手术后出现败血症，随后进行了多次结肠造口术和结肠造口闭合手术。 (B) 手指从腹壁按压 Palmer 点，显示肠环卡在上腹部。 Jain 点可避免 IIA 型肠粘连。

Jain点腹腔镜入路Palmers点的禁忌证

图 2
(A) Jain点的概念； 它模仿坐在手术场外的网球场上裁判的位置。 (B) Jain 点同样适用于上腹部、中腹部和下腹部疤痕。

Jain点腹腔镜入路Palmers点的禁忌证

图 3
Jain点在L4水平，脐旁10-13cm，远离左侧脏器（脾、肾、胃胀）和乙状结肠，左侧宽新生区从L1到 盆腔，没有血管、内脏、粘连和肠管。

Jain点腹腔镜入路Palmers点的禁忌证

图 4
(A) 在 Jain 点端口的直视下插入 10mm 端口，成为主要工作端口。 (B) 同侧端口使肌瘤切除术和缝合符合人体工程学。

由于其解剖学位置，Jain 点是一种可行的入口选择，在其他端口有限制的情况下并发症发生率较低。 该端口对于上腹部、中腹部和下腹部所有类型的先前疤痕都是安全的，并且可用于所有 BMI 范围。 根据手术需要，它可以用作右侧的镜像。 它位于中腹部，兼作符合人体工程学的主要工作端口。 它没有已知的禁忌症。 Jain 点可用作所有腹腔镜从业者在以前的 Palmer 点禁忌患者手术病例中的入口。

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