Mac Cordick C, Lécuru F, Rizk E, Robin F, Boucaya V, Taurelle R
Service de Gynécologie-Obstétrique, Hôpital Boucicaut, 78 rue de la Convention, 75015 Paris, France.
Surg Endosc. 1999 Jan;13(1):57-61. doi: 10.1007/s004649900898.
We set out to investigate prospectively the morbidity rate for gynecological laparoscopy patients at a tertiary care center.
We prospectively recorded data on 743 laparoscopic procedures performed between January 1, 1992 and December 31, 1996. The procedures included 36 diagnostic laparoscopies (4.8%), 115 laparoscopies carried out for minor surgical acts (15.4%), 523 for major surgical acts (70.4%), and 69 for advanced surgical acts (9. 4%). A total of 127 patients had a history of prior laparotomy (17%). All those procedures were performed by young senior surgeons. We defined a complication as an event that had modified the usual course of the procedure or of the postoperative period. For statistical analysis, we used the chi-squared test or Fisher's exact test.
Complications occurred in 22 cases; the overall complication rate was 2.9% when all events were considered. One complication (injury of the left primitive iliac artery) was related to insertion of the Veress needle (0.13%). A total of 2,578 trocars were inserted, giving rise to 10 complications (1.3%). Three unintended laparotomies were required for bowel or bladder injuries (0.4%). Finally, the introduction of the laparoscope was responsible for 11 complications (1.4%); this figure represents 50% of all the complications of this series. Eight intraoperative complications (1%) occurred during the laparoscopic surgery (seven severe bleedings and one ureter injury, but no intestinal lesions); laparotomy was required in six of these cases. Three complications occurred during the postoperative stage: one granulomatous peritonitis after intraabdominal rupture of a dermoid cyst, one incisional hernia, and a fast-resolving cardiac arrhythmia.
In our experience, operative gynecological laparoscopy is associated with an acceptable morbidity rate. Moreover, about half of the complications occur during the installation of the laparoscopic procedure, underscoring the usefulness of safety rules.
我们着手对一家三级医疗中心的妇科腹腔镜手术患者的发病率进行前瞻性研究。
我们前瞻性地记录了1992年1月1日至1996年12月31日期间进行的743例腹腔镜手术的数据。这些手术包括36例诊断性腹腔镜检查（4.8%）、115例用于小型手术操作的腹腔镜检查（15.4%）、523例用于大型手术操作的腹腔镜检查（70.4%）以及69例用于高级手术操作的腹腔镜检查（9.4%）。共有127例患者有既往剖腹手术史（17%）。所有这些手术均由年轻的资深外科医生进行。我们将并发症定义为改变手术常规进程或术后病程的事件。对于统计分析，我们使用卡方检验或费舍尔精确检验。
发生并发症22例；当考虑所有事件时，总体并发症发生率为2.9%。1例并发症（左髂总动脉损伤）与韦雷斯针插入有关（0.13%）。共插入2578枚套管针，引发10例并发症（1.3%）。因肠道或膀胱损伤需要进行3例意外剖腹手术（0.4%）。最后，腹腔镜的插入导致11例并发症（1.4%）；该数字占本系列所有并发症的50%。8例术中并发症（1%）发生在腹腔镜手术期间（7例严重出血和1例输尿管损伤，但无肠道病变）；其中6例需要进行剖腹手术。3例并发症发生在术后阶段：1例皮样囊肿腹腔内破裂后发生肉芽肿性腹膜炎、1例切口疝和1例快速缓解的心律失常。
根据我们的经验，妇科手术腹腔镜检查的发病率是可以接受的。此外，约一半的并发症发生在腹腔镜手术安装过程中，这突出了安全规则的实用性。
