上海市14所医院近10年妇科内镜手术并发症的分析

Analysis of complications about gynecologic endoscopic procedures in 14 hospitals of Shanghai during 1992-2001

目的 探讨妇科内镜手术并发症发生的规律。方法 回顾性调查分析上海市 9所三级医院和 5所二级医院近 10年妇科内镜手术 (腹腔镜和宫腔镜手术 )并发症发生情况。结果 14所医院共进行妇科手术性腹腔镜手术 10 2 63例 ,并发症 15 5例 ,发生率 1 5 1% ;宫腔镜手术 183 0 6例 ,并发症16例 ,发生率为 0 0 9%。腹腔镜手术最常见的并发症是出血性并发症 ,70例 ,发生率 0 68% ,占并发症总数的 45 2 % (70 / 15 5 ) ,其他主要并发症为感染性并发症 18例、脏器损伤性并发症 12例 ,发生率各为 0 18%、0 12 % ;主要并发症在非经验者中的发生率为有经验者的 6倍 (P <0 0 1) ;从 1992～ 2 0 0 1年 ,并发症发生率由 7 2 5 %下降至 0 90 %。宫腔镜手术并发症为子宫穿孔 6例 ,液体超负荷 3例 ,心脑综合征 2例 ,术后出血 3例 ,内脏损伤 1例 ,死亡 1例 ,死亡率 0 0 0 5 % ;并发症年发生率为 0 0 4%～0 2 0 %。进行宫腔镜手术不到 10 0 0例医院的并发症发生率为手术超过 10 0 0例医院的 16倍 (P<0 0 1)。结论 内镜手术并发症发生呈逐年下降趋势。随手术范围的扩大 ,出血性并发症、脏器损伤性并发症有所增加 ,并发症的发生与手术者的手术经验有关。要降低妇科内镜手术并发症发生率 ,应重视适应证的选择、内镜?

Objective To investigate the objective law of complication in endoscopic operation of gynecology Method We retrospectively reviewed and analyzed the complications of endoscopic surgery during the decade occurred in 9 municipal or teaching hospitals and 5 district hospitals in Shanghai Results There were total 10 263 cases of operative laparoscopy and 18 306 cases of hysteroscopy The laparoscopic complication rate was 1 51%(155/ 10 263) and incidence of hysteroscopic complication was 0 09%(16/ 18 306) The major common complications in laparoscopic procedures were bleedings (70/ 10 263, 0 68%), 18 infections (18/ 10 263, 0 18%) and 12 organic injuries (12/ 10 263, 0 12%) The complication rate in laparoscopic surgery made by the inexperienced was six times greater than that by the experienced ( P <0 01) Complication rate decreased to 0 90% in 2001 from 7 25% in 1992 The complications in hysteroscopy were 6 uterine perforations, 3 hyperhydration syndromes, 3 postoperative bleedings, 2 cardio brain syndrome, 1 organic injury, and 1 died The mortality was 0 005% The complication rate in the hospital developing hysteroscopic surgery less than 1 000 cases was 16 times greater than in that over 1 000 cases ( P <0 01) Conclusions It is suggested by our data that the complication in laparoscopy showed downward year by year and some serious complications were increased with extension of operative surgery Complication has to do with the experience of surgeons To decrease complication, surgeons should pay a great attention to the indication chosen correctly, training step by step and basic skills