腹腔镜手术并发症27例相关因素分析

Complications in laparoscopic gynecologic surgery:analysis of 27 c ases

目的 探讨腹腔镜手术的并发症及其相关因素。方法 回顾性研究西南医院妇产科近 2年的 2 2 14例腹腔镜手术病例及 2 7例出现并发症的病例情况。手术包括附件手术 172 1例 ,子宫肌瘤挖除术 15 0例 ,子宫次全切术 2 10例 ,子宫全切 133例。并发症指术中出现的需额外处理或术后出现的因手术本身引起需进行再次手术或保守治疗的情况。结果 并发症发生率为1 2 2 % ,需手术处理者 2例 (0 0 9% )。附件手术、子宫肌瘤挖除、子宫次全切除术、子宫全切术的并发症发生率分别为 0 5 2 %、2 0 0 %、3 33%及 6 0 1%。与穿刺及气腹有关的并发症 14例 (5 1 9% ) ,包括腹壁血管损伤、严重皮下气肿及气腹针断裂 ;术中并发症 3例 (11 1% ) ,其中肠管损伤 2例 ,1例改开腹手术 ,另 1例为电极胸部皮肤烧伤 ;术后并发症 10例 (37 0 % ) ,为术后发热。结论 妇科腹腔镜手术并发症不容忽视 。

Objective To investigate retrospectively the complica ti on rate of gynecological laparoscopies at the Southwest Hospital near 2-year pe riod.Methods 2 214 laparoscopic surgeries were carried out from M ar.2000 through Dec.2001.included 1 721 adnexal surgeries,150 myomectomies,210 s ubtotal hysterectomy and 133 total hysterectomy.Complication was defined as an e vent that had modified the usual course of the procedure or of the postoperative period.Results Complications occurred in 27 cases, the over comp lication rate was 1.22%.2 out of the 27 cases needed surgical treatment.complica tion rate was 0 52%?2 00%?3 33% and 6.01% in adnexal surgeries,myomectomies , subtotal hysterectomy, total hysterectomy repectively.14 complications related to puncture and pneumopertioneum, including 4 injuries to epigastric blood vess els of abdominal wall, 9 severe emphysema and 1 paracentetic needl ruptured.This figure represented 51.9% of all complications of this series.3(11.1%) introaper ative complications occurred during the laparoscopic surgery (2 bowel injury and lskin burn of chest related to the electric coagulator), laparotomy was require d in 1 of these cases.10(37 0%) complications occurred during postoperative sta ge:febrile morbidities.Conclusion Operative gynecologic laparosco py is associated with acceptable morbidity rate,but can not be overlooked.Compli cations seems related to advandced procedures.