腹腔镜结直肠手术术中意外情况20例处置分析

Disposal of severe intraoperative complications in 20 cases of laparoscopic colorectal surgery

目的探讨腹腔镜辅助结直肠手术中出现较严重意外情况的原因及处置方法。方法回顾性分析首都医科大学附属北京朝阳医院普通外科2010年1月至2015年1月完成腹腔镜结直肠手术并出现较严重术中意外的20例病人资料。结果 20例术中意外情况均得到妥善处理,未引起严重后果。其中术中大出血11例,分别为右结肠动脉2例、左侧阴部内静脉大出血5例、骶前静脉丛出血4例。女性直肠子宫陷凹处直肠壁炎性狭窄5例。直肠癌吻合后乙状结肠系膜360-扭转1例。直肠癌及乙状结肠癌术中近端肠管血运障碍3例。结论腹腔镜结直肠手术操作越来越精细,对于各种术中意外情况采取相应的防范与处置对策,可以降低手术风险。

Objective To explore the cause and disposal of severe accidents in laparoscopic colorectal surgery. Methods The clinical data of 20 cases of laparoscopic colorectal surgery with severe intraoperative complications from January 2010 to January 2015 in Department of General Surgery, Beijing ChaoYang Hospital, Capital Medical University were analyzed retrospectively. Results All 20 cases were treated appropriately without serious consequences. Eleven cases of massive hemorrhage include 2 cases of right colic artery, 5 cases of left internal pudendal vein, 4 cases of venous plexus of presacral region. There were 5 cases of rectum inflammatory stricture in rectouterine pouch, I case of 360 degree torsion of sigmoid colon after anastomosis of rectal carcinoma, 3 cases of blood supply disorder of proximal colon segment during proctosigmoid surgery. Conclusion Laparoscopic colorectal surgery has become more and more sophisticated. The risk of the surgery could be reduced if appropriate preventive and disposal measures are taken for a variety of unforeseen circunstances.