腹腔镜手术并发症34例分析

Complications in laparoscopic gynecologic surgery: analysis of 34 cases

目的 探讨腹腔镜手术的并发症及其相关因素。方法 回顾性分析北京协和医院妇产科近 6年的 176 9例腹腔镜手术病例及 34例出现并发症的病例情况。手术包括附件手术 142 1例 ,子宫肌瘤剔除术 5 2例 ,腹腔镜辅助的阴式子宫切除术 2 96例。并发症指术中出现的需行额外处理或术后出现的因手术本身引起需行再次手术或保守治疗的情况。结果 并发症发生率为 1 9%。需开腹手术处理者 6例 (0 3% )。附件手术、肌瘤剔除术及阴式子宫切除术的并发症发生率分别为 0 9%、1 9%及 6 8%。与穿刺及气腹有关的并发症 12例 (35 3% ) ,包括腹壁血管、大网膜血管损伤及严重的皮下气肿 ;术中并发症 5例 (14 7% ) ,其中大出血 3例、膀胱破裂 1例 ,均改开腹手术 ,另 1例为负极板放置处大腿皮肤烧伤 ;术后并发症 17例 (5 0 0 % ) ,其中 2例术后腹腔内出血再次开腹止血。术后并发症还包括肠道并发症、神经麻痹及发热。结论 妇科腹腔镜手术的并发症不容忽视 ,并发症的发生与手术的难度有关。

Objective To investigate retrospectively the complication rate of gynecological laparoscopies at Peking union medical college (PUMC) hospital over 6 year period Methods 1 769 laparoscopic surgeries were carried out from Jan 1994 through Oct 1999 The procedures included 1 421 adnexal surgeries, 52 myomectomies and 296 laparoscopic assisted vaginal hysterectomy (LAVH) Complication was defined as an event that had modified the usual course of the procedure or of the postoperative period Results Complications occured in 34 cases, the overall complication rate was 1 9% Unintended laparotomies occured in 6 cases (0 3%) Complication rate was 0 9%、1 9% and 6 8% in adnexal surgeries, myomectomies and LAVH respectively 12 (35 3%) complications related to puncture and pneumoperitoneum, including five severe emphysema, 7 injuries to epigastric blood vessels of abdominal wall and omental blood vessel, this figure represented 35 3% of all complications of this series 5 (14 7%) intraoperative complications occured during the laparoscopic surgery (3 severe bleedings, 1 bladder injury and 1 skin burn of leg related to the electrode plate), laparotomy was required in 4 of these cases 17 (50 0%) complications occured during postoperative stage: 2 intraperitoneal hemorrhages needing re laparotomy, 2 bowel complications, 4 nerve paresis and 9 febrile morbidities Conclusions In our experience, operative gynecologic laparoscopy is associated with acceptable morbidity rate,but can not be overlooked Complications seems related to advanced procedures such as LAVH