妇科腹腔镜手术并发症15例分析

Complications of Laparoscopic Gynecologic Surgery:Analysis of 15 Cases

目的探讨妇科腹腔镜手术发生并发症的原因。方法我院妇科2005～2009年共完成各种妇科腹腔镜手术1128例,发生感染、出血、器官损伤、异物残留等明显并发症15例,回顾性分析这15例的临床资料。结果术后感染5例,其中3例盆腔感染,均经加强抗感染治疗体温正常(肌瘤剔除1例术后10个月因一直下腹痛行子宫次全切除,病理示子宫伤口处与大网膜粘连并钙化);2例切口感染,引流、换药1周治愈。术后腹腔内出血7例,2例(腹腔镜子宫肌瘤剔除术1例,次全子宫切除术1例)出血快术后当天开腹手术止血,其余5例保守治疗治愈。输尿管损伤1例,腹腔镜下右附件切除术中电凝钳损伤输尿管,放置双J管2个月治愈。异物残留2例,负压引流管折断滞留腹壁筋膜下1例局麻下取出,滞留盆腔1例腹腔镜下取出。结论并发症的发生和手术相关人员对相关知识的掌握程度、术者技术的娴熟度、镜下解剖识别度及各环节工作是否仔细有关。

Objective To investigate the causes of complications in laparoscopic gynecologic surgery.Methods Totally 1128 cases of laparoscopic gynecologic surgery were done in our hospital between 2005 and 2009,15 of them developed complications including infection,bleeding,organ injury or residual foreign body.A retrospective analysis of the clinic data of the 15 patients was made in this study.Results Among the cases,injection was developed in 5 patients,3 of them showed pelvic infections,and was then cured by antibiotics（one of the patients received subtotal hysterectomy because of continuous lower abdominal pain,which was then diagnosed with omental adhesion and calcification by pathological examination）;the other 2 patients had incisional infection and was cured in one week by drainage and changing dressings.Postoperative intra-abdominal hemorrhage was found in 7 cases,2 of them（laparoscopic myomectomy was performed in one,and subtotal hysterectomy in another）was cured by laparotomy and the other 5 were controlled by conservative therapies.In one patient,the ureter was injured by electronic coagulation,and thus been with a double-J catheter for 2 weeks.Two patients showed residual foreign body after the operation,which was turned out to be negative pressure drainage tubes remained under the fascia or in the abdominal cavity during the operation;both of the patients were cured by laparoscopy.Conclusion The complications of laparoscopic gynecologic surgery are correlated with the operators＇ knowledge of the procedure,skill of the technique,and familiarity to laparoscopic anatomy.