摘要
目的探讨妇科腹腔镜手术中发生血管损伤的原因、处理及预防. 方法回顾分析我院1994年7月～2004年6月6 416例全麻腹腔镜手术中发生血管损伤的临床资料,分析其相关因素. 结果 6 416例妇科腹腔镜手术中血管损伤13例,其中9例腹壁下血管损伤,3例大网膜血管损伤,2例髂血管损伤,发生率0.2%(13/6 416).9例由于腹壁套管针穿刺所致, 4例由于术中操作引起,包括1例腹壁下动脉损伤、1例大网膜血管损伤以及2例髂血管损伤.发生血管损伤的主要原因是盆、腹腔中、重度粘连,视野暴露困难,局部解剖不清.1例腹壁下动脉损伤、1例大网膜血管损伤行腹腔镜下成功止血,其余9例均中转开腹手术.无一例死亡. 结论腹腔镜手术中血管损伤可发生于操作中的任何阶段,与医生的手术经验明显相关,盆、腹腔粘连是血管损伤发生的危险因素.加强腹腔镜操作技能培训,提高穿刺技术是减少腹腔镜手术中血管损伤的关键.
Objective To investigate the causes, treatment and prevention of vascular injuries during laparoscopic gynecologic surgery. Methods Clinical records of 6 416 cases of gynecologic laparoscopy under general anesthesia from July 1994 to June 2004 in this hospital were retrospectively reviewed. Cases of blood vessel injuries were further analyzed. Results Vascular injuries happened in 13 cases, involving the inferior epigastric blood vessels (9 cases), the greater omentum blood vessels (3 cases), and iliac blood vessels (2 cases), respectively, with an incidence of 0 2% (13/6 416). Injuries were caused by trocar introduction in 9 cases and by intraoperative performance in 4 cases (including 1 case of injuries of the inferior epigastric artery, 1 case of injuries of the greater omentum blood vessels, and 2 cases of injuries of the iliac blood vessels). Main causes accounting for the injuries were moderate-to-severe pelvic or abdominal adhesion, difficulties in the exposure of the surgical field, and inaccurate local anatomies. Bleeding was successfully stopped under laparoscope in 1 case of injuries of the inferior epigastric artery and 1 case of injuries of the greater omentum blood vessels, while a conversion to open surgery was required in the remaining 9 cases. No death occurred. Conclusions Vascular injuries may take place at any stages during a laparoscopic surgery and apparently correlated with surgeon’s experience. Pelvic or abdominal adhesion is an important cause leading to the vascular injuries. For the prevention of the injuries, it is crucial to intensify the training of laparoscopic techniques.
出处
《中国微创外科杂志》
CSCD
2005年第3期178-180,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜
妇科
血管损伤
Laparoscopy
Gynecology
Vascular injury
