Schrenk P, Woisetschläger R, Rieger R, Wayand W
Second Surgical Department, Akh Linz-Ludwig Boltzmann Institute for Surgical Laparoscopy, Austria.
Gastrointest Endosc. 1996 Jun;43(6):572-4. doi: 10.1016/s0016-5107(96)70193-1.
Inadvertent injury to the bowel is a rare but potentially fatal complication of laparoscopy. Such injury often goes unrecognized at the time of the procedure and only later is manifest by high morbidity and mortality.
We reviewed the mechanism and management of 10 instances of bowel injury known to have been encountered in a series of 4672 laparoscopic procedures performed at our hospital over the past 5 years.
The usual causes of injury to the bowel wall were thermal burns, sharp dissection, and needle punctures. Six of the injuries were readily evident and treated immediately; four were unrecognized until 2 to 14 days after the procedure. One patient died of multiple organ failure on the third day after laparoscopy. Operative management in nine cases required simple closure or segmental resection. A high index of suspicion and vigilant physical examination were the keys to early recognition of bowel injury; laboratory and radiographic findings were nonspecific.
Suspected bowel injury following laparoscopy mandates early laparotomy to avoid life-threatening complications.
肠道意外损伤是腹腔镜手术中一种罕见但可能致命的并发症。这种损伤在手术过程中常常未被识别，直到后来才表现出高发病率和死亡率。
我们回顾了过去5年在我院进行的4672例腹腔镜手术中已知遇到的10例肠道损伤的机制及处理方法。
肠壁损伤的常见原因是热灼伤、锐性分离和针刺伤。其中6例损伤很明显并立即得到处理；4例直到术后2至14天才被发现。1例患者在腹腔镜检查后第三天死于多器官功能衰竭。9例患者的手术处理需要简单缝合或节段性切除。高度的怀疑指数和警惕的体格检查是早期识别肠道损伤的关键；实验室和影像学检查结果不具有特异性。
腹腔镜检查后怀疑肠道损伤时应尽早剖腹探查，以避免危及生命的并发症。
