Hurd W W, Pearl M L, DeLancey J O, Quint E H, Garnett B, Bude R O
Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor.
Obstet Gynecol. 1993 Oct;82(4 Pt 2 Suppl):673-6.
Operative laparoscopy is being used for an increasing number of applications. Many of these innovative techniques require the insertion of large trocars through the anterior abdominal wall at points lateral to the midline. Because of the rich vascular supply of the anterior abdominal wall, the incidence of abdominal wall vessel injuries appears to be increased by these techniques.
Three cases are reported in which abdominal wall blood vessels were injured during operative laparoscopy. Case 1 describes laceration of the inferior epigastric artery above the pubic crest. Despite initial hemostasis with a transabdominal suture ligation, postoperative blood loss necessitated transfusion and reoperation to control bleeding. Case 2 describes hematoma formation after unrecognized injury to one of the epigastric vessels. The hematoma resolved without sequelae with conservative treatment. Case 3 describes hematoma formation under a laparoscopic trocar incision lateral to the umbilicus that progressed to an abscess and was treated with drainage, irrigation, and antibiotics.
Choosing appropriate trocar types and insertion sites based on a thorough understanding of anterior abdominal wall anatomy may minimize the risk of vessel injury during operative laparoscopy. However, because of anatomical variation, strategies for managing vessel injuries and their sequelae are also necessary.
手术腹腔镜的应用越来越广泛。许多这些创新技术需要在中线外侧的点通过前腹壁插入大口径套管针。由于前腹壁丰富的血管供应，这些技术似乎会增加腹壁血管损伤的发生率。
报告了3例手术腹腔镜检查期间腹壁血管损伤的病例。病例1描述了耻骨嵴上方腹壁下动脉的撕裂伤。尽管最初通过经腹缝线结扎止血，但术后失血仍需要输血和再次手术以控制出血。病例2描述了在未识别的情况下上腹部血管之一受伤后形成血肿。通过保守治疗，血肿消退，无后遗症。病例3描述了脐旁腹腔镜套管针切口下形成血肿，该血肿发展为脓肿，并接受了引流、冲洗和抗生素治疗。
在充分了解前腹壁解剖结构的基础上选择合适的套管针类型和插入部位，可在手术腹腔镜检查期间将血管损伤风险降至最低。然而，由于解剖变异，处理血管损伤及其后遗症的策略也是必要的。
