Leng J, Lang J, Huang R, Liu Z, Sun D
Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730.
Chin Med Sci J. 2000 Dec;15(4):222-6.
To investigate retrospectively the complications and associated factors of gynecolgical laparoscopies.
1 769 laparoscopic surgeries were carried out from January 1994 to October 1999 at our department. The procedures included 1421 surgeries of ovary and tube, 52 myomectomies and 296 cases of laproscopic-assisted vaginal hysterectomy (LAVH). A total of 312 patients had a history of prior laparotomy (17.6%).
Complications occured in 34 cases, the overall complication rate was 1.92%. Unintended laparotomies occured in 6 cases (0.34%). 12 complications were associated with insertion of Veresse needle or trocar and creation of pneumoperitoneum, including 5 severe emphysema and 7 vascular injuries, this figure represents 35.3% of all complications of this series. Five intraoperative complications (14.7%) occured during the laparoscopic surgery (3 severe bleedings, one bladder injury and one skin burn of leg caused by damaged electrode plate), laparotomy was required in four of these cases. Seventeen complications occured during postoperative stage: 2 intraperitoneal hemorrhages needing laparotomy, 2 bowel injuries, 4 nerve paresis and 9 febrile morbidities.
Operative gynecologic laparoscopy is associated with acceptable morbidity rate, but can not be overlooked. Complication rate seems to be higher in advanced procedures such as LAVH.
回顾性研究妇科腹腔镜手术的并发症及相关因素。
1994年1月至1999年10月，我科共进行了1769例腹腔镜手术。手术包括1421例卵巢和输卵管手术、52例子宫肌瘤切除术以及296例腹腔镜辅助阴式子宫切除术（LAVH）。共有312例患者有既往开腹手术史（17.6%）。
发生并发症34例，总并发症发生率为1.92%。意外开腹6例（0.34%）。12例并发症与Veress针或套管针插入及气腹形成有关，包括5例严重气肿和7例血管损伤，该数字占本系列所有并发症的35.3%。5例术中并发症（14.7%）发生于腹腔镜手术期间（3例严重出血、1例膀胱损伤和1例因电极板损坏导致的腿部皮肤烧伤），其中4例需要开腹。17例并发症发生于术后阶段：2例腹腔内出血需要开腹、2例肠损伤、4例神经麻痹和9例发热性疾病。
妇科腹腔镜手术的发病率可接受，但不容忽视。在诸如LAVH等复杂手术中，并发症发生率似乎更高。
