| 妇科腹腔镜手术中转开腹原因分析 |
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| 引用本文： | 朱忆晨,王才智.妇科腹腔镜手术中转开腹原因分析[J].蚌埠医学院学报,2021,46(4):509-511. |
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| 作者姓名： | 朱忆晨 王才智 |
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| 作者单位： | 1.蚌埠医学院 临床医学院, 安徽 蚌埠 2330302.蚌埠医学院第一附属医院 妇产科, 安徽 蚌埠 233004 |
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| 摘 要： | 目的分析妇科腹腔镜手术中转开腹发生情况及其影响因素。方法采用回顾性分析方法，收集2014-2018年蚌埠医学院第一附属医院2 683例妇科腹腔镜手术病人资料，根据已实施腹腔镜手术方式，分为4组:Ⅰ类（腹腔镜检查或附件手术），Ⅱ类（卵巢囊肿剥除术或卵巢及附件切除术），Ⅲ类（子宫肌瘤剔除术、子宫次全或全切除术），Ⅳ类（广泛子宫切除术+盆腔淋巴结清扫术）。分析中转开腹病人的手术方式及中转开腹的原因。结果2 683例腹腔镜手术病人，中转开腹22例，中转开腹率0.81%。其中Ⅰ~Ⅳ类手术中转开腹率分别为0.36%（6/1 680）、0.97%（3/310）、1.52%（10/660）9.09%（3/33）。4组不同手术方式中转开腹率不同，Ⅰ类、Ⅱ类和Ⅲ类均低于Ⅳ类，差异有统计学意义（P < 0.01）。中转开腹原因依次为重度粘连36.36%（8/22），特殊部位病变22.73%（5/22），出血18.18%（4/22），术中诊断的恶性肿瘤13.64%（3/22），误伤9.09%（2/22）。结论妇科腹腔镜手术中转开腹的发生主要与手术操作的难易程度及需要手术的范围密切相关。严格术前评估和手术适应证的遴选、采用适宜的手术方式、提高术者操作技能是预防妇科腹腔镜中转开腹发生的有效方法。
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| 关 键 词： | 腹腔镜手术 妇科 中转开腹 |
| 收稿时间： | 2019-06-05 |
Analysis of the causes of conversion to laparotomy in gynecological laparoscopy surgery |
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| ZHU Yi-chen,WANG Cai-zhi.Analysis of the causes of conversion to laparotomy in gynecological laparoscopy surgery[J].Journal of Bengbu Medical College,2021,46(4):509-511. |
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| Authors: | ZHU Yi-chen WANG Cai-zhi |
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| Affiliation: | 1.School of Clinical Medicine, Bengbu Medical College, Bengbu Anhui 2330302.Department of Obstetrics and Gynecology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China |
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| Abstract: | ObjectiveTo analyze the incidence of conversion to laparotomy in gynecological laparoscopy surgery, and its influencing factors.MethodsThe clinical data of 2 683 patients of gynecological laparoscopy surgery in The First Affiliated Hospital of Bengbu Medical College from 2014 to 2018 were retrospectively analyzed.According to the laparoscopic surgery methods, the patients were divided into the type Ⅰ group(treatment with laparoscopy or appendage surgery), type Ⅱ group(treatment with ovariectomy or ovariectomy), type Ⅲ group(treatment with myomectomy, subtotal or total hysterectomy) and type Ⅳ group(treatment with extensive hysterectomy combined with pelvic lymphadenectomy).The operation methods and reasons of conversion to laparotomy in 22 patients were analyzed.ResultsAmong the 2 683 laparoscopic patients, 22 cases were converted to laparotomy, and the conversion rate was 0.81%.The conversion rates of type Ⅰ, Ⅱ, Ⅲ and Ⅳ groups were 0.36%(6/1 680), 0.97%(3/310), 1.52%(10/660) and 9.09%(3/33), respectively.The conversion rates in type Ⅰ, Ⅱ and Ⅲ groups were lower than that in type Ⅳ group(P < 0.01).The causes of conversion to laparotomy included the severe adhesions36.36%(8/22)], special lesions22.73%(5/22)], bleeding18.18%(4/22)], malignant tumors13.64%(3/22) and injuries9.09%(2/22)].ConclusionsThe occurrence of conversion to laparotomy in gynecological laparoscopy surgery is closely related to the difficulty of operation and scope of operation required.The strict preoperative evaluation, selection of surgical indications, use of appropriate surgical methods and improvement of operative skills are the effective methods to prevent gynecological laparoscopy conversion to laparotomy. |
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