腹腔镜子宫切除术中即刻中转开腹手术原因分析其及术后处理

目的探讨腹腔镜子宫切除术时，即刻中转开腹手术的原因及处理，即刻中转开腹指征及意义。方法回顾分析本院1999年1月至2007年12月间831例腹腔镜子宫切除术中42例即刻中转开腹患者的临床资料。结果腹腔镜子宫切除术中即刻中转开腹手术的发生率为5．05％，主要原因有严重的盆腹腔粘连、下腹部手术史、出血并发症等。结论有多次下腹部手术史可疑盆腔粘连及子宫过大者，选择腹腔镜子宫切除时应慎重；正确掌握中转开腹手术的时机及开腹手术后的处理方法，是降低腹腔镜子宫切除手术并发症的有效措施。

Objective To study on the cause of immediate conversion to laparotomy during laparoscopic hysterectomy and postoperative treatment, as well as the indications. Methods Of 831 Laparoscopic hysterectomy cases from Januaray 1991 to December 2007 in our hospital, clinical data of 42 patients who were immediately converted to laparotomy were analyzed retrospectively. Result The laparotomy incidence rate was 5.05%, mainly due to severe abdominopelvic cavity adhesions, hemorrhage, hypogastric zone operation history and complications. Conclusion Careful choice should be made when considering laparoscopic hysterectomy for patients with multiple hypogastric zone operation history, questionable pelvic cavity adhesions and too big uterus. Decision of converting to laparotomy and correct postoperative treatment are the effective measures to lower complication of laparoscopic hysterectomy.