Asfour Victoria, Smythe Edward, Attia Rizwan
a Department of Urogynaecology , St Mary's Hospital, Imperial College London , London , UK.
b Department of General Surgery , Musgrove Park Hospital , Taunton , UK.
J Obstet Gynaecol. 2018 Jul;38(5):598-606. doi: 10.1080/01443615.2017.1410120. Epub 2018 Apr 5.
Vascular laparoscopic injuries are rare (0.2/1000), however, they are associated with 6-13% morbidity and mortality. Commonest sites for catastrophic haemorrhage are the right iliac vessels, inferior vena cava and less commonly the abdominal aorta. The injuries commonly occur at entry using a Veress needle or insertion of trocars. These risks are inherent to all laparoscopic surgery. A systematic approach for managing these includes prompt recognition, communication within the operative team, immediate resuscitation and specific operative strategies for the control of vascular haemorrhage based on the location and severity of the injury. Major vascular injuries may require midline laparotomy and vascular surgeons. 1:1:1 resuscitation and adjunct haemostatic agents may help. Major vascular injury is a rare but a potentially fatal complication. We propose a skills and drills approach to improve outcomes. We also propose a practical algorithms for the management of haemorrhage in the acute situation.
血管腹腔镜损伤很少见（每1000例中有0.2例），然而，它们与6% - 13%的发病率和死亡率相关。灾难性出血最常见的部位是右髂血管、下腔静脉，较少见的是腹主动脉。损伤通常发生在使用韦雷氏针穿刺或插入套管针时。这些风险是所有腹腔镜手术固有的。处理这些情况的系统方法包括迅速识别、手术团队内部沟通、立即复苏以及根据损伤的部位和严重程度控制血管出血的特定手术策略。严重的血管损伤可能需要正中剖腹术并请血管外科医生会诊。1:1:1复苏和辅助止血剂可能会有帮助。严重血管损伤是一种罕见但可能致命的并发症。我们建议采用技能训练方法来改善治疗结果。我们还提出了一种在急性情况下处理出血的实用算法。
