妇科腹腔镜手术并发症临床分析与处理

Clinical analysis and treatment of 92 case of complications of laparoscopic gynecologic surgery

目的探讨妇科腹腔镜手术并发症的发生原因、处理及预防。方法对该院妇科2006年6月～2009年8月完成的2951例妇科腹腔镜手术及其并发症进行回顾性分析。结果 2951例腹腔镜手术中有92例出现并发症,发生率为3.12%。附件手术并发症发生率最低1.19%,其次是子宫肌瘤剔除和子宫次全切除术,分别为2.53%和2.84%,全子宫切除和子宫(次)广泛切除术加盆腔淋巴结清扫术的并发症较前三者明显增高,分别为5.01%和30.38%,子宫(次)广泛切除术加盆腔淋巴结清扫术并发症最多、手术风险最大。92例并发症包括皮下气肿15例,腹壁血管损伤7例,脏器损伤(膀胱、输尿管及肠管)12例,尿潴留2例,粘连性肠梗阻4例,下肢感觉活动异常5例,特发性腹水2例,淋巴囊肿2例,术后病率24例,双侧卵巢囊肿剔除术后闭经2例,阴道断端感染裂开1例,缝合针迷失1例。结论腹腔镜手术难度越大,手术并发症越多,应慎重选择腹腔镜手术病例,尤其是既往有盆腹腔手术史、盆腹腔粘连明显或难度大的手术。妇科腹腔镜手术并发症应该积极预防和作有效处理。

【Objective】To investigate the causes,management and prevention of the complications of laparoscopic gynecologic surgery. 【Methods】2,951 Iaparoscopic gynecologic surgeries and complications were analyzed retrospectively from June 2006 to August 2009.【Results】Complications occurred in 92 cases,the overall complication rate was 3.12%. The complication rate of laparoscopic annex operation was the least （1.19%）,the next was in the laparoscopic myomectomy （2.53%） and laparoscopically subtotal hysterectomy（LSH） （2.84%）; The complication rate in total laparoscopic hysterectomy （TLH） and laparoscopic subradical or radical hysterectomy with pclvic lymphadenectomy was 5.01% and 30.38% and more than others,especially in the last. The complications included 15 case of pneumoderma,7 case of beri-operation bleeding,12 case presented viscera injury,2 case were urine retention,intestinal obstruction occurred in 4 case,5 case were abnormal of activity of lower limbs,idiopathic ascites were 2 case,there were 2 case of lymphocyst and 24 case postoperative morbidity,2 patients were amenorrhea after laparoscopic bilateral ovarian cystectomy,1 case presented vaginal stump infection and 1 case was needle lost. 【Conclusions】With the increase of the difficulty of laparoscopic gynecologic surgery,the complications were increased. We should select indication carefully,especially in the cases which had histories of pelvic,abdominal operations and severe adhesion or more difficult operations. We should prevent and treat the complications of laparoscopic gynecologic surgery actively.