腹腔镜胃癌根治术中医源性损伤的原因分析与防治

Causes,Prevention,and Management of Iatrogenic Injuries in Laparoscopic Surgery for Gastric Cancer

目的分析腹腔镜胃癌根治术中医源性损伤的原因。方法 2008年1月~2009年12月共行腹腔镜胃癌根治手术117例（包括全胃切除术32例,近端胃大部切除术27例,远端胃大部切除术58例）,发生医源性损伤9例（7.7%）。回顾分析这9例的临床资料。结果脾损伤4例,压迫止血,成功保脾;横结肠损伤1例,辅助小切口以1号线缝合修补;横结肠系膜血管损伤1例,辅助小切口行横结肠部分切除端端吻合;肝左动脉损伤1例,未处理;肝脏挫裂伤1例,辅助小切口以1号线间断缝合挫裂口;残胃浆膜挫裂伤1例,可吸收线间断缝合修补。9例均治愈出院。结论腹腔镜胃癌根治术中医源性损伤多发生在开展本手术的早期,与显露不佳、操作不当有关。

Objective To analyze the causes of iatrogenic injuries during laparoscopic procedures for patients with gastric cancer. Methods From January 2008 to December 2009,117 patients with gastric cancer received laparoscopic radical gastrectomy,including 32 cases of total gastrectomy,27 cases of proximal subtotal gastrectomy,and 58 cases of distal subtotal gastrectomy.Among the cases,9 patients（7.7%） developed iatrogenic injuries,whose clinical data were analyzed retrospectively.Results In the 9 cases of iatrogenic injuries,4 patients developed injuries to the spleen,and were then cured by compression hemostasis;one patient showed transverse colon injury,which was repaired by using 1# suture;one patient had injury to the transverse mesocolon vessels and thus received partial transverse colectomy;one patient was found with left hepatic artery transection and therefore been observed closely;one patient underwent repair due to hepatic laceration;and one patient were treated by suturing for the rupture of remnant stomach serosa. Conclusions Iatrogenic injury often occurs at the early stage of laparoscopic radical gastrectomy.Insufficient exposure of the operational field and improper procedures are major causes of the injury.