腹腔镜盆腔脏器联合切除术中意外及对策

Intraoperative accidents and countermeasures in laparoscopic pelvic exenteration

腹腔镜直肠癌联合盆腔脏器切除需面临盆腔解剖认知及腔镜技术的双重考验,术者要掌握结直肠外科、泌尿外科、妇科、骨科、整形外科等多学科知识,并能在复杂场景里快速识别重要解剖标志,因而极具挑战性。术中不仅要关注常规腹腔镜直肠手术的出血、肠管损伤或盆神经丛损伤等并发症,还要关注盆腔侧向间隙的术中意外,包括髂内血管出血、输尿管损伤、闭孔神经甚至腰骶干损伤;同时,盆腔前方间隙的术中意外:膀胱三角损伤、阴茎背静脉复合体出血及女性内生殖器官损伤的风险也应引起足够的重视。

The surgeon performing laparoscopic pelvic exenteration for rectal cancer must face the double challenge of pelvic anatomy cognition and laparoscopic techniques.The surgeon must master multidisciplinary knowledge such as colorectal surgery,uroloy,gynecology,orthopedics and plastic surgery thus could quickly identify important anatomical landmarks in complex scenes.The surgeon should pay attention to intraoperative accidents not only involve bleeding,bowel injury or pelvic plexus injury as conventional laparoscopic rectal surgery,but also accidents in the lateral pelvic space,including internal iliac vessel bleeding,ureteral injury,obturator nerve,and even lumbosacral trunk injury.At the same time,the risk of intraoperative accidents in the anterior pelvic space:bladder triangle injury,dorsal venous complex bleeding,and internal reproductive organ damage in female patients should also be attracted enough attention.