妇科腹腔镜手术中转开腹的原因及预防

Reasons and prophylaxes of conversion to laparotomy during gynecological laparoscopic surgery

目的探讨妇科腹腔镜手术中转开腹的原因及其预防措施。方法回顾性分析1143例妇科腹腔镜手术中36例中转开腹患者的临床资料。结果中转开腹率为3．15％。中转开腹的主要原因：盆腹腔粘连23例（63．89％）、术中操作困难或并发症8例（22．22％）、恶性肿瘤3例（8．33％）。有下腹部手术史和开展腹腔镜手术初期中转开腹率较高。结论妇科腹腔镜手术中转开腹的最主要原因为盆腹腔粘连。加强术前对患者病情的评估、提高手术操作技巧可以降低腹腔镜手术中转开腹率。

Objective To study the reasons and prophylaxes of conversion to laparotomy during gy- necological laparoscopic surgery. Method Clinical records of 36 cases of conversion to laparotomy out of 1143 cases of gynecological laparoscopie surgery were analyzed retrospectively. Results The rate of conver- sion to laparotomy was 3.15%. The reasons of conversion to laparotomy were abdominopelvic cavity adhesion in 23 cases, technical difficulty and complication in 8 cases, malignant tumor in 3 cases, accounting for 63.89%, 22.22%, 8.33%, respectively. The rate of conversion to laparotomy in patients with a history of laparotomy was significantly higher than that without a history of laparotomy. The rate of conversion to laparoto- my in early stage of developing laparoseopic surgery was significantly higher than that in other stages. Conelusiollts Abdominopelvic cavity adhesion is the primary reason of conversion to laparotomy during gyneco- logical laparoseopic surgery. Careful evaluation before surgery and improving ability of performance can decrease the rate of conversion to laparotomy.