妇科腹腔镜手术后特发性腹水9例临床分析

Idiopathic postoperative ascites after laparoscopic gynecological surgery:A preliminary study of 9 cases

目的探讨妇科腹腔镜手术后少见并发症——特发性腹水的病因、诊断、鉴别诊断及处理。方法回顾分析该院2004年7月～2005年10月妇科行腹腔镜手术后不明原因大量腹水的诊治情况。结果期间共有9例患者出现不明原因腹水,年龄23～54岁;所行手术包括腹腔镜下子宫肌瘤剥除术、输卵管切除术、输卵管切开取胚术、卵巢囊肿剥除术、附件切除术以及腹腔镜辅助下阴式全子宫切除术等;出现腹水的时间多为手术后当天开始到术后5d,最晚1例在手术后2周发生;腹水总量可达1650～9200mL;多数患者无明显临床症状,少数有腹胀、恶心、呕吐等不适;腹水检查提示肌酐值与血肌酐值接近,Rivalta试验均为阳性或弱阳性,提示为渗出液;血生化检查提示血清总蛋白正常或降低;所有患者经一般支持治疗后腹水逐渐减少而痊愈。结论妇科腹腔镜术后特发性腹水是一种少见的并发症,可能与术中腹膜受到热损伤、二氧化碳以及器械消毒液等的刺激等有关,可通过腹水检查与泌尿道、肠管等相关脏器损伤所致的腹水相鉴别,及时支持治疗有效,预后好。

[Objective] The aim of this study was to describe the clinical characteristics of the rare complication of idiopathic postoperative ascites after laparoscopic gynecological surgery in our hospital from July, 2003 to Oct 2005. [Methods] The hospital charts of 9 women displayed idiopathic post postoperative ascites after laparoscopic gynecological surgery were reviewed and analyzed. [Results] There were 9 cases of patients with idiopathic post postoperative ascites during the time. The median age of patients was 36.7 （range 23-54 years）. The operations include laparoscopy-assisted myomectomy, ophorocystectomy, salpingectomy, adnexectomy and LAVH, etc. The median operation time was 70.7 minutes （range 32-140 minutes）. Ascites of these patients mostly occurred during the first day to the 5th day after operations except for one case which occurred in the 14th day after operation. The median total volume of ascites was 3826 mL （range 1650-9200 mL）. There were no specific symptoms and physical signs of these cases except for few complaining of abdominal distention, nausea and vomiting. The biochemistry test results showed an equal volume of creatinine in ascites and urines. [Conclusions] Idiopathic postoperative ascites is a rare complication of laparoscopic procedures. It may be caused by peritoneal injury. The patients can recover with general treatments.