Härkki-Siren P, Sjöberg J, Kurki T
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland.
Obstet Gynecol. 1999 Jul;94(1):94-8.
To examine recent figures on major laparoscopic complications in Finland.
This was a nationwide record-linkage study from January 1995 through December 1996 including all Finnish hospitals performing gynecologic laparoscopies. Data files of the National Patient Insurance Association and the Finnish Hospital Discharge Register were used. Data were compared with previous results from 1990 to 1994.
Among 32,205 gynecologic laparoscopies, 130 major complications were noted. The total complication rate was 4.0 per 1000 procedures: 0.6 per 1000 in diagnostic laparoscopies, 0.5 per 1000 in sterilization, and 12.6 per 1000 in operative laparoscopies. Intestinal injuries were reported in 0.7 per 1000, incisional hernias in 0.3 per 1000, urinary tract injuries in 2.5 per 1000, major vascular injuries in 0.1 per 1000, and other injuries in 0.5 per 1000 gynecologic laparoscopic procedures. Seventy-five percent (88 of 118) of the major complications in operative laparoscopies occurred during hysterectomies. The total major complication rate decreased from 4.9% in 1993 to 2.3% in 1996 (chi2 = 8.55, P = .003), but the incidence of ureteral injuries remained stable, at about 1% of laparoscopic hysterectomies. Ureteral injuries were most common in local hospitals (2.6%), followed by central (1.1%) and university hospitals (0.9%). From 1990 through 1996, the relative risk for ureteral injury in laparoscopic hysterectomies, compared with other operative laparoscopies was 29.0 (95% confidence interval [CI] 13.3, 63.0), for bladder injury 13.0 (95% CI 6.0, 28.2), for intestinal injury 1.3 (95% CI 0.6, 2.5), and for major vascular injury 0.4 (95% CI 0.1, 3.6). Compared with the figures for 1990-1994, all major complications in operative laparoscopies increased, from 0 per 1000 in 1990 to 14.0 per 1000 in 1996 (chi2 = 20.28, P<.001), but part of this increase was due to the increased proportion of laparoscopic hysterectomies.
Laparoscopic hysterectomies are still associated with a stable 1% risk of ureteral injury, whereas other major complications were decreasing until 1996. Complications in other laparoscopic procedures generally are rare.
研究芬兰近期主要腹腔镜手术并发症的数据。
这是一项1995年1月至1996年12月的全国性记录关联研究，涵盖了芬兰所有开展妇科腹腔镜手术的医院。使用了国家患者保险协会和芬兰医院出院登记处的数据文件。将数据与1990年至1994年的先前结果进行比较。
在32205例妇科腹腔镜手术中，发现130例主要并发症。总并发症发生率为每1000例手术4.0例：诊断性腹腔镜手术中为每1000例0.6例，绝育手术中为每1000例0.5例，手术性腹腔镜手术中为每1000例12.6例。每1000例中报告有0.7例肠道损伤，0.3例切口疝，2.5例尿路损伤，0.1例主要血管损伤，以及每1000例妇科腹腔镜手术中有0.5例其他损伤。手术性腹腔镜手术中75%（118例中的88例）的主要并发症发生在子宫切除术中。主要并发症总发生率从1993年的4.9%降至1996年的2.3%（χ² = 8.55，P = 0.003），但输尿管损伤的发生率保持稳定，约为腹腔镜子宫切除术的1%。输尿管损伤在地方医院最为常见（2.6%），其次是中心医院（1.1%）和大学医院（0.9%）。1990年至1996年，与其他手术性腹腔镜手术相比，腹腔镜子宫切除术中输尿管损伤的相对风险为29.0（95%置信区间[CI] 13.3，63.0），膀胱损伤为13.0（95% CI 6.0，28.2），肠道损伤为1.3（95% CI 0.6，2.5），主要血管损伤为0.4（95% CI 0.1，3.6）。与1990 - 1994年的数据相比，手术性腹腔镜手术中的所有主要并发症均有所增加，从1990年的每1000例0例增至1996年的每1000例14.0例（χ² = 20.28，P < 0.001），但部分增加是由于腹腔镜子宫切除术比例的增加。
腹腔镜子宫切除术仍有1%的稳定输尿管损伤风险，而其他主要并发症在1996年前呈下降趋势。其他腹腔镜手术的并发症一般很少见。
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