妇科腹腔镜手术中转开腹的原因及其对策

Causes and countermeasure of conversions to open surgery in patients received gynecological laparoscopic operations

目的分析妇科腹腔镜手术中转开腹的相关因素,制定应对措施。方法回顾性分析妇科腹腔镜手术21例中转开腹患者的临床资料。结果本组中转开腹率为0.377%(21/5569),其原因依次为:严重盆腔粘连10例,占47.6%、特殊部位子宫(腺)肌瘤8例,占38.1%、子宫肌瘤个数过多1例,占4.76%、卵巢恶性疾病1例、术中直肠损伤1例。结论严重盆腔粘连是导致妇科腹腔镜手术中转开腹的首要原因,其次是特殊部位子宫肌瘤,术前严格掌握适应证,加强术前病情评估,提高腹腔镜手术操作技巧,可减少中转开腹率;而适时中转开腹可减少并发症的发生,达到手术的预期目的 。

[Objective] To study the causes of conversion to open surgery in patients received gynecological laparoscopic operations.[Methods] Clinical records of 21 cases of conversion to open surgery were analyzed retrospectively.[Results] The rate of conversion to laparotomy was 0.377%（21/5569）.The reasons of conversion to laparotomy were severe pelvic adhesion in 10 cases（47.6%）.The uterusmyoma located at specific locations 8 cases（38.1%）.The excessive number of uterine myoma 1 case（4.76%）,ovarian tumor 1case,rectum surgical injury 1 case.[Conclusions] Severe pelvic adhesion is the main causes of conversion to open surgery during gynecological laparoscopy.Peculiar location of uterine myoma is the second reason.Mastering the operation indications well,detailed preoperative evaluation,improved ability of performance can decrease the rate of the conversion rate.Right timing of the conversion may reduce complication rate and achieve operation purpose.