妇科腹腔镜手术中转开腹的临床分析

Clinical analysis of gynecological laparoscopy converting to laparotomy

目的探讨妇科腹腔镜手术中转开腹的常见原因及预防措施。方法对湖州市妇幼保健院近5年接受妇科腹腔镜手术的3912例患者的临床资料进行回顾性分析。结果 67例中转开腹手术,中转开腹手术率为1.71%。中转开腹原因:严重盆腹腔粘连27例(40.30%),特殊部位病变21例(31.34%),术中大出血8例(11.94%),恶性肿瘤6例(8.96%),手术并发症3例(4.48%),外科疾病2例(2.98%)。子宫手术的转开腹率最高(6.88%),显著高于卵巢手术(1.28%)、输卵管手术(0.71%)及不孕症手术(0.37%)(均P<0.01)。结论严重的盆腹腔粘连和病变部位特殊是妇科腹腔镜手术转开腹的主要原因。加强术前评估、严格掌握腹腔镜手术指征可降低中转率,适时中转开腹可减少并发症发生。

【Objective】To explore clinical factors and preventive measure of gynecological laparoscopy converting to laparotomy. 【Method】3912 patients underwent laparoscopy within the recent 5 years were retrospectively analyzed. 【Results】The total conversion rate was 1.71%（67/3192）. The main factors were pelvic adhesion 40.30% （27/67）, unusual location of lesion 31.34%（21/67）, bleeding 11.94%（8/67）, malignant tumor 8.96%（6/67）, operative complications 4.48%（3/67） and surgical diseases 2.98%（2/67）. The conversion rate in uterus surgery （6.88%） was significantly higher than that in ovary surgery （1.28%）, tube surgery （0.71%） and infertility surgery （0.37%） （P 0.01）. 【Conclusions】The main factors of conversion are pelvic adhesion and unusual location of lesions. Comprehensive evaluation of patients＇ preoperative condition and selection of proper cases might reduce the rate of conversion. It＇s suitable to convert to laparotomy to reduce the incidence of complications.