腹腔镜手术治疗127例妇科恶性肿瘤并发症分析

Analysis of complications in 127 gynecological malignancies patients with laparoscopic surgery

目的 探讨妇科恶性肿瘤腹腔镜手术后并发症发生的相关情况及预防措施。方法 回顾性分析2010年5月~2014年12月于湖北省妇幼保健院行腹腔镜手术治疗的60例ⅠA2~ⅡA2期宫颈癌、49例ⅠA~ⅢC2期子宫内膜癌、18例ⅠA~ⅢC期卵巢恶性及交界性肿瘤患者术中及术后并发症的发生情况。结果 127例妇科恶性肿瘤腹腔镜手术中,3例中转开腹,中转开腹率为2.36%。总体并发症发生率为23.62%,主要包括血管损伤、神经损伤、膀胱损伤、尿潴留等。其中宫颈癌手术并发症发生率高于子宫内膜癌和卵巢癌（P〈0.05）,子宫内膜癌与卵巢癌并发症发生率比较,差异无统计学意义（P〉0.05）。并发症中,宫颈癌术后尿潴留发生率较子宫内膜癌及卵巢癌高（P〈0.05）,而其他并发症发生率比较,差异无统计学意义（P〉0.05）。结论 随着腹腔镜妇科恶性肿瘤手术难度增大,并发症发生率增加;熟练掌握腹腔镜手术技巧,严格遵循手术指征及把握合适的开腹时机可减少并发症的发生。

Objective To investigate the related conditions and preventive measures of complications of laparoscopic surgeries in patients with gynecological malignancies. Methods A retrospective study about complications was conducted on 60 cases of cervical cancer with International Federation of Gynecology and Obstetrics stage Ⅰ A2- Ⅱ A2, 49 cases of endometrial cancer with stage Ⅰ A-Ⅲ C2, 18 cases of ovarian cancer and borderline ovarian tumors with stage Ⅰ A-Ⅲ C who underwent laparoscopie surgery from May 2010 to December 2014 in Hubei Maternal and Child Health Hospital. Results In 127 patients who underwent laparoscopic operation, only 3 cases changed to laparotomy, the conversion rate was 2.36%. The overall complication rate was 23.62% among 127 cases. The main types of complications included vascular injury, nerve damage, bladder injury, urinary retention and so on. Higher complication rate was observed in laparoseopic cervical cancer surgery than that in endometrial cancer and ovarian carcinoma （P 〈 0.05）, while there was no statistically significant difference between endometrial cancer and ovarian carcinoma on surgical complications （P 〉 0.05）. In specific complications, the incidence of urinary retention after cervical cancer surgery was higher than that of endometrial cancer and ovarian carcinoma （P 〈 0.05）, while there were no significant statistically significant differences in the incidence of other complications （P 〉 0.05）. Conclusion With the difficulty of laparoscopic gynecologic malignant tumor, the incidence of complications increases. Proficiency in laparoscopie surgery, selecting the correct surgical indications and proper opportunity for laparotomy can reduce the occurrence of complications in gynecological malignant tumor surgery.