Nordestgaard A G, Bodily K C, Osborne R W, Buttorff J D
Cascade Vascular Associates, Tacoma, Washington 98405, USA.
Am J Surg. 1995 May;169(5):543-5. doi: 10.1016/s0002-9610(99)80214-1.
Major vascular complications following laparoscopic procedures are rare, with only 20 cases reported in the literature.
The cases of 4 patients who sustained 5 vascular injuries during laparoscopic procedures between June 1991 and May 1994 are presented, and previously reported cases in the literature are reviewed.
All injuries occurred during pelvic laparoscopy (2 diagnostic procedures, 1 tubal ligation, and 1 hernia repair). The vascular injury was recognized during laparoscopy in 3 patients. In only 1 patient was immediate vascular surgery consultation requested. The iliac artery was injured in 3 patients, the iliac vein in 1, and the inferior epigastric artery in 1. The mechanism of injury was by the trocar in 2 patients and by sharp dissection in 2 patients. Arterial repair was accomplished by polytetrafluoroethylene (PTFE) interposition, PTFE patch angioplasty, resection and primary anastomosis, and ligation in 1 patient each. The venous injury was repaired by lateral venorrhaphy. Three patients recovered without sequelae, and 1 patient had a stroke. A review of the literature revealed only 20 reported cases of major vascular injuries as a result of the pneumoperitoneum needle or trocar insertion. Characteristically, the terminal aorta, cava, iliac arteries, and veins were injured. Most injuries were treated by direct suture repair. With immediate recognition, recovery was the rule; however, 3 of the 8 patients with delayed recognition died.
Laparoscopists must be aware of this rare, serious, and potentially lethal complication. Once recognized, immediate conversion to an open procedure and application of appropriate vascular surgical techniques are required to reestablish arterial and venous continuity and minimize morbidity and mortality.
腹腔镜手术后的主要血管并发症很罕见，文献中仅报道了20例。
本文介绍了1991年6月至1994年5月期间4例患者在腹腔镜手术中发生5处血管损伤的病例，并对文献中先前报道的病例进行了回顾。
所有损伤均发生在盆腔腹腔镜手术期间（2例诊断性手术、1例输卵管结扎术和1例疝修补术）。3例患者在腹腔镜手术期间发现血管损伤。仅1例患者立即请求血管外科会诊。3例患者髂动脉受损，1例髂静脉受损，1例腹壁下动脉受损。损伤机制为2例患者因套管针所致，2例患者因锐性分离所致。动脉修复分别采用聚四氟乙烯（PTFE）置入、PTFE补片血管成形术、切除并一期吻合以及1例患者结扎。静脉损伤采用侧方静脉缝合修复。3例患者康复且无后遗症，1例患者发生中风。文献回顾显示，因气腹针或套管针插入导致的主要血管损伤仅报道了20例。特征性地，终末主动脉、腔静脉、髂动脉和静脉受损。大多数损伤采用直接缝合修复。若能及时识别，通常可康复；然而，8例延迟识别的患者中有3例死亡。
腹腔镜手术医生必须意识到这种罕见、严重且可能致命的并发症。一旦识别，需立即转为开放手术并应用适当的血管外科技术以重建动静脉连续性，将发病率和死亡率降至最低。
