妇科腹腔镜中转开腹原因分析

Clinical Analysis for Conversion From Gynecological Laparoscopic Surgery to Laparotomy

目的探讨妇科腹腔镜中转开腹的相关因素。方法回顾性分析我院近2年来1 342例接受妇科腹腔镜手术病例中27例中转开腹的原因。结果中转开腹率为2.0%。主要原因为子宫肌瘤部位特殊8例(29.6%)、盆腔粘连7例(25.9%)、子宫腺肌症或腺肌瘤要求保留子宫者5例(18.5%)、恶性肿瘤3例(11.1%)、OHSS合并右卵巢囊肿蒂扭转1例(3.7%)、左输卵管间质部妊娠1例(3.7%)双子宫双宫颈合并阴道斜膈、左侧宫颈管闭锁1例(3.7%)等。因并发症即出血而中转开腹者1例,占3.7%。结论子宫肌瘤部位特殊、盆腔粘连等为妇科腹腔镜中转开腹最常见的原因。加强对患者术前病情的评估可以减少中转开腹率。适时中转开腹可以减少手术并发症的发生。

Objective Tostudy the clinical factors in conversion from gynecolgical laparoscopy to laparotamy. Methods Laparoscopic surgery that was perfomed in 1,342 gynecology patients within the recent 2years was analyzed retrospectively. Results Among them, 27 patients were converted to laparotomy （25.9%）,adenomyosis of adenomyoma and required to avoid uterectomy （18.5%）,mallgnant tumors （11.1%）, torsion of the pedicle of ovarian cyst （3.7%）,interstitial tubular pregnancy（3.7%）,uterus didelphys with oblique vaginal septum and left cervical atresia （3.7%）,and bleeding（3.7%）.Conclusions Peculiar location of uterus myoma and pelvic adinesion are the main causes of corrversion from gyneoological laparoscopy to laparotomy .Careful evaluation before surgery is important to reduce the rate of conversion to laparotomy.To convert from laparoscopy to laparotomy at the right moment may help to reduce unnecessary complications.