腹腔镜胃癌根治术医源性损伤的原因分析

Cause of iatrogenic injuries in laparoscopic surgery for radical gastrectomy

目的:分析腹腔镜胃癌根治术中医源性损伤发生的原因。方法:回顾2012年1月到2013年9月本医疗组完成的113例腹腔镜胃癌根治术手术视频,发现医源性损伤11例,并回顾分析相应的病例资料,对其发生原因进行总结分析。结果:11例医源性损伤中,结肠系膜损伤1例,脾脏损伤4例,血管损伤6例,包括肝固有动脉损伤1例,门静脉损伤1例,脾静脉损伤2例,胃短动脉损伤1例,脾上极血管损伤1例;上述医源性损伤均是由于解剖不清晰,术者之间相互配合不好所致。结论:术中解剖不清晰,术者间配合欠佳是腹腔镜胃癌根治术医源性损伤发生的主要原因。

Objective：To analyze the cause of iatrogenic injuries during the laparoscopic procedures for patients with radical gastrectomy. Methods：Totally 113 laparoscopic surgery videos for radical gastrectomy were reviewed,which had been performed from January 2012 to September 2013. Eleven iatrogenic injuries were revealed and related clinical data were analyzed further. Results：Among11 iatrogenic injuries,1 patient had mesocolon injury,4 patients had spleen injuries,6 patients had blood vessels injuries including 1patient with proper hepatic artery injury,1 patient with portal vein injury,2 patients with splenic vein injury,1 patient with short gastric artery injury,1 patient with upper pole splenic artery injury. All injuries above were caused by unclear dissection and lack of cooperation in operation. Conclusion：The main causes of iatrogenic injuries in laparoscopic surgery for radical gastrecotmy are unclear dissection and poor cooperation among surgeons.