Jansen F W, Kapiteyn K, Trimbos-Kemper T, Hermans J, Trimbos J B
Department of Gynaecology, Leiden University Hospital, The Netherlands.
Br J Obstet Gynaecol. 1997 May;104(5):595-600. doi: 10.1111/j.1471-0528.1997.tb11539.x.
To determine the incidence and describe the complications of laparoscopic procedures in The Netherlands.
A nationwide prospective multicentre observational study.
Data on complications were registered from 1 January to 31 December 1994 by 72 hospitals. Any unexpected or unplanned event requiring intra-operative or post-operative intervention was defined as a complication. Complications were classified in two groups: approach and technique related complications. Complication rates were compared with these already published.
Of 25,764 laparoscopic procedures, 145 complications occurred (rate 5.7 per 1000 [/1000]); two deaths occurred. In 84 women laparotomy was necessary (rate 3.3/1000). In 83 cases (57%; 95% CI for approach = 49-65%) the complication was caused by the surgical approach; in 62 cases (43%) the technique was at fault. Haemorrhage of the epigastric vein and intestinal injury, often requiring laparotomy (90% of cases) were the most frequently observed complications. The complication rate was 2.7/1000 for diagnostic laparoscopic procedures, 4.5/1000 for sterilisation and 17.9/1000 (chi 2 = 127; dF = 2; P < 0.001) for operative laparoscopy. The highest incidence was registered for complications occurring during laparoscopic (assisted) hysterectomy. Stepwise logistic regression analysis showed that previous laparotomy and surgical experience were associated with complications requiring laparotomy.
Most complications occurred during operative laparoscopic procedures (rate 17.9/1000). Residents in training are required to learn diagnostic laparoscopy and sterilisation and this training programme results in a fall in the risk of the complications. However, operative laparoscopic procedures are still hazardous, especially laparoscopic hysterectomy. Women with a previous laparotomy are particularly at risk.
确定荷兰腹腔镜手术的发生率并描述其并发症。
一项全国性前瞻性多中心观察性研究。
1994年1月1日至12月31日期间，72家医院记录了并发症数据。任何需要术中或术后干预的意外或非计划性事件被定义为并发症。并发症分为两组：入路相关并发症和技术相关并发症。将并发症发生率与已发表的数据进行比较。
在25764例腹腔镜手术中，发生了145例并发症（发生率为每1000例中有5.7例[/1000]）；有2例死亡。84名女性需要进行剖腹手术（发生率为3.3/1000）。83例（57%；入路相关并发症的95%置信区间为49 - 65%）并发症由手术入路引起；62例（43%）是技术问题。上腹壁静脉出血和肠损伤是最常观察到的并发症，通常需要剖腹手术（90%的病例）。诊断性腹腔镜手术的并发症发生率为2.7/1000，绝育手术为4.5/1000，手术性腹腔镜手术为17.9/1000（χ² = 127；自由度 = 2；P < 0.001）。腹腔镜（辅助）子宫切除术中并发症的发生率最高。逐步逻辑回归分析表明，既往剖腹手术和手术经验与需要剖腹手术的并发症有关。
大多数并发症发生在手术性腹腔镜手术期间（发生率为17.9/1000）。住院医师培训要求学习诊断性腹腔镜手术和绝育手术，该培训计划可降低并发症风险。然而，手术性腹腔镜手术仍然具有危险性，尤其是腹腔镜子宫切除术。既往接受过剖腹手术的女性风险尤其高。
