妇科腹腔镜手术并发症原因分析

Analysis of influencing factors of complications of gynecological laparoscopic surgery

目的探讨腹腔镜下妇科手术并发症的发生情况及相关影响因素。方法对2012年1月至2016年10月在山东临清市人民医院妇科采用腹腔镜手术551例患者的手术并发症发生情况和患者年龄、体质量指数(body mass index,BMI)、手术史、子宫大小、子宫内膜病史等并发症影响因素进行回顾性分析。结果①551例腹腔镜手术患者中有50例发生并发症,发生率为9.07%。其中穿刺和气腹建立时的并发症5例,术中并发症32例,主要为大量失血(28例),术后并发症13例,主要为术后感染10例。Ⅰ(子宫附件手术)、Ⅱ(子宫肌瘤剔除术)、Ⅲ(子宫次切术和全子宫切除术)、Ⅳ(妇科恶性肿瘤根治术)类手术的并发症率依次为1.25%(2/160)、4.2%(6/141)、11.3%(17/150)、25.0%(25/100)。②根据单因素分析,未发生并发症和发生并发症患者在BMI、手术医师工作年限、手术类型、腹腔手术史和子宫内膜病史方面差异有统计学意义(P>0.05)。③通过多因素Logistic回归分析发现3个影响并发症率的因素:医师工作年限(OR=7.796,P<0.05)、腹腔手术史(OR=6.634,P<0.05)、手术类型(OR=0.423,P<0.05)。结论腹腔镜下妇科手术中最常见的并发症是术中大量出血和术后感染。BMI、手术医师工作年限、手术类型、腹腔手术史和子宫内膜病史可能与并发症发生相关;而医师工作年限、腹腔手术史和手术复杂程度是并发症发生的危险因素。

Objective To investigate the complications of laparoscopic gynecological surgery and the related influencing factors. Methods 551 patients who underwent laparoscopic surgery in Shandong Linqing People＇s Hospital from January 2012 to October 2016 were selected, the incidence of complications, age, body mass index （BMI）, surgery history, uterine enlargement, endometriosis and other influencing factors were retrospective analyzed. Results （1） The overall complication incidence rate is 9. 1% （ 50/551 ） ,including 5 cases of pneumoperitoneum and puncture complications,32 cases of intraoperative complications, large blood loss mainly （28 cases）, 13 cases of postoperative complications, postoperative infection mainly. The complication occurrence rate of Ⅰ, Ⅱ, Ⅲ,Ⅳ operation were 1.25 % （2/160） , 4. 2 % （ 6/141 ）, 11.3 % （ 17/150） , 25.0 % （ 25/100）. （2） According to the single factor analysis, the differences of doctors＇ skill, operation type, BMI, history of abdominal surgery and endometriosis history between the patients with complications and patients without complications were statistically significant （ P 〈 0. 05 ） . （3） According to the Logistic muhifactor analysis, doctors＇ work experience （ OR = 7. 796 ,P 〈 0. 05 ） , history of abdominal surgery （ OR = 6. 634, P 〈 0. 05） and the operation type （ OR = 0. 423, P 〈 0. 05 ） were the influence factors of complication incidence rate. Conclusion Intraoperative bleeding and postoperative infection are the most common major complications of laparoscopic gynecological surgery. BMI index, physician experience, surgical type, history of abdominal surgery and endometriosis may be related to the occurrence of complications ; and physician working years, history of abdominal surgery and surgical complexity are the risk factors of complications.