妇科腹腔镜手术中转开腹原因的研究

A study on the causes changed from laparoscopic operation of gynecology to open laparotomy.

目的 探讨妇科腹腔镜手术中转开腹的原因及其防治。 方法 回顾分析 1995年 6月- 2 0 0 0年 6月间 2 117例接受妇科腹腔镜手术病例中 98例中转开腹的原因。 结果 本组中转开腹率为 4.6 % (98/ 2 117) ,主要原因为严重盆腹腔粘连和出血 ,分别为 5 9.1% (5 8/ 98)和 18.3 % (18/ 98) ,另有术野暴露困难 (非粘连性 )、恶性病变及膀胱损伤等 ;中转开腹率 ,有腹部手术史者 13.4% (5 1/ 379) ,明显高于无腹部手术史者 2 .7% (47/ 1738) ,子宫手术者 7.6 % (6 7/ 872 ) ,明显高于附件手术者 3 % (2 7/ 90 0 ) ,差异极显著 (P <0 .0 0 1)。 结论 腹腔镜子宫手术、有腹部手术史 ,严重出血和盆腹腔粘连是中转开腹的重要原因 。

Objective To study the causes changed from laparoscopic operation of gynecology to open laparotomy and their prophylaxis and treatments. Methods Beween June 1995 and June 2000 the causes of 98 patients changed from laparoscopic operation of gynecology to open laparotomy from 2117 patients with laparoscopic operation of gynecology were reviewed retrospectively. Results The rate of laparoscopic operation of gynecology converted to open laparotomy was 4.6%. Main causes converted to open laparotomy were severe pelvic peritoneal adhesion (59.1%), bleeding (18.3%), a poor exposure of operative field, malignant pathological lesions and severe injuries etc. The rate converted to open laparotomy in patients with a history of laparotomy (13.4% , 51/379) was significantly higher than that in those without a history of laparotomy (2.7%, 47/1738) , P<0.001. The rate converted to open laparotomy in patients underwent operation on the uterus (7.6%, 67/872) was significantly higher than that of those underwent on the adnex (3%, 27/900), P<0.001. Conclusions Laparoscopic operation on the uterus and a history of laparotomy, severe pelvic peritoneal adhesion and bleeding were important reasons converted to open laparotomy.