妇科腹腔镜手术中转开腹53例多因素分析

Analysis of multi-factors in conversion from gynecological laparoscopy to laparotomy in 53 cases

目的探讨妇科腹腔镜手术中转开腹的影响因素。方法回顾性分析我院2009年9月至2013年9月2890例妇科腹腔镜手术中53例中转开腹的临床资料,并采用多元logistic回归分析妇科腹腔镜手术中转开腹的原因。结果中转开腹53例,中转开腹率1.83%,中转开腹的原因：未预计的特殊部位子宫肌瘤13例（24.53%）,严重盆腹腔粘连19例（35.85%）,止血困难4例（7.55%）。卵巢恶性肿瘤（包括盆腔巨大肿块）14例（26.42%）,手术损伤（血管或输尿管）3例（5.66%）。腹腔镜中转开腹的影响因素为腹部手术史（OR 3.076,95%CI 2.457~3.276）、盆腔粘连程度（OR3.909,95%CI 2.858~4.226）、术中出血（OR 3.491,95%CI 2.778~3.576）、疾病类型（OR 1.869,95%CI 1.243~2.263）和手术方式（OR 1.906,95%CI 1.321~2.211）,患者年龄与中转开腹无关。结论手术医师腹腔镜手术操作能力,手术前加强病情的评估能够减少术中转开腹率,而及时中转开腹恰恰能够减少手术并发症的发生。

Objective To discuss the influential factors on conversion from gynecological laparoscopy to laparotomy.Methods Fifty-three of 2890 gynecological laparoscopies in our hospital were converted to laparotomy from September2009 to September 2013. The data of these 53 cases were analyzed in this article. The influential factors on conversion from gynecological laparoscopy to laparotomies were analyzed with logistic regression.Results The causes of conversion from laparoscopy to laparotomy included uterus myoma located at specific locations（n=13,24.53%）, severe pelvicabdominal adhesion（n=19,35.85%）,severe bleeding（n=4,7.55%）,ovarian malignant tumors（n=14,26,42%） and surgical injury（n=3,5.67%）. The influential factors were ：history of operation（OR 3.076,95%CI 2.457~3.276）,severe adhesion（OR 3.909,95%CI 2.858~4.226）, intraoperative blood loss（OR 3.491,95%CI 2.778~3.576）, type of disease（OR 1.869,95%CI 1.243~2.263）and operative approaches（OR 1.906,95%CI 1.321~2.211）.Age and history of abdominal operation were not the influential factors. Conclusion Improving the operation technique of gynecology and careful evaluation of patients before surgery are important to reduce the conversion percentage from laparoscopy to laparotomy. Prompt conversion from laparoscopy to laparotomy can reduce complications.