腹腔镜下子宫全切除/次全切除手术并发症的原因分析及防治

目的 探讨腹腔镜下子宫全切/次全切除手术并发症的原因和防治措施.方法 对2004年1月-2010年10月2475例腹腔镜下子宫全切/次全切除手术的临床资料进行回顾性分析.结果 发生并发症279例（11.3%）,其中出血10例、肠道热灼伤4例、膀胱损伤1例、输尿管损伤1例、皮下气肿118例、感染10例、神经损伤7例、术后肩痛114例、暴露性角膜炎5例、皮肤电损伤5例、输卵管自阴道切缘脱出1例、切口疝3例.并发症中开腹处理1例,再次腹腔镜手术7例.2004-2006年并发症234例,手术并发症发生率31.4%（234/746）,2007-2010年并发症45例,手术并发症发生率2.6%（45/1729）.279例并发症中,以皮下气肿和术后肩痛多见,其中204例发生在前三年,28例发生在后四年,发生率分别为27 3%（204/746）、1.6%（28/1729）.结论 手术操作技术不成熟、腹腔镜开展初期、术中视野暴露不佳、穿刺口过大、未辨清解剖结构盲目操作、盆腹腔严重粘连、切口异物污染、腹腔内气体残留、穿刺口未避开腹壁血管是发生并发症的关键.     

早期开展腹腔镜胃癌手术的并发症分析

目的探讨早期开展腹腔镜胃癌手术出现的并发症及预防、治疗措施。方法回顾性分析2009年6月-2010年6月50例腹腔镜胃癌D2手术的临床资料,包括手术方式、中转开腹率、手术时间、术中出血量、手术并发症等。腹腔镜下行D2淋巴清扫,上腹小切口切除标本并消化道重建。结果完成腹腔镜手术42例,无围手术期死亡,中转开腹率16%（8/50）。术中并发症发生率8%（4/50）,其中重要血管损伤引起出血3例,横结肠系膜损伤1例;术后早期并发症发生率14%（7/50）,其中腹腔内出血1例,十二指肠残端漏1例,残胃排空障碍3例,术后切口感染1例,支气管肺炎1例。结论掌握腔镜下特有的解剖层面,提高手术技巧,建立规范的操作步骤,加强团队配合,是防治腹腔镜胃癌手术并发症的关键。     

妇科腹腔镜手术并发症诊治分析

目的分析妇科腹腔镜手术并发症的发生原因,探讨降低并发症发生的预防措施。方法对济源市卫生学校附属医院妇科2004年11月至2007年10月280例经腹腔镜治疗的妇科患者的临床资料进行回顾性分析。结果280例中发生并发症13例,发生率为4.6%,包括出血2例,肩痛7例,子宫穿孔2例,感染1例,腹壁血肿1例。除外不需处理的肩痛和子宫穿孔,实际发生率为1.4%。结论并发症可发生于手术不同的阶段,提高医生的内镜手术技能和手术技巧,严格按规范操作,充分了解各种器械设备的性能,可降低妇科腹腔镜手术并发症的发生率。     

后腹腔镜手术并发症分析及处理策略

目的总结我科后腹腔镜手术并发症,分析其原因和处理方法,以提高手术安全性。方法回顾性分析新疆医科大学第一附属医院泌尿外科2010年8月至2014年3月施行680例后腹腔镜手术的临床资料,总结与后腹腔镜操作相关的并发症,分析发生原因及处理对策。结果本组680例后腹腔镜手术共发生75例与腹腔镜有关的并发症,占11.0%(75/680例),严重并发症包括腹腔器官损伤的发生率为0.88%(6/680例),血管损伤的发生率为1.2%(8/680例)。术中并发症包括:胸膜损伤2例,腹膜损伤24例,胰腺尾部损伤3例,十二指肠损伤2例,血管损伤8例(腔静脉6例,中央静脉2例),脾脏损伤1例,皮下气肿27例,改开放手术8例;术后并发症包括:后腹腔间隙血肿1例,漏尿2例,切口感染5例,死亡1例,患糖尿病1例,其余均痊愈。结论通过不断总结经验教训,提高对后腹腔镜手术技术和并发症的认识,增进腹腔镜相关解剖知识的理解,做到精准细致的操作,可最大限度的降低手术并发症。     

妇科腹腔镜手术有关并发症的预防及临床分析

目的探讨妇科腹腔镜手术相关并发症的发生原因、处理及预防措施。方法对我院2010年1月-2011年12月的3076例妇科腹腔镜手术的临床资料进行回顾性分析。结果3076例手术中，腹腔镜手术相关并发症17例，发生率0．55％，其中阴道残端愈合不良3例，切口疝、腹壁切口出血、膀胱损伤、肌瘤残留各1例需要再次手术；3例出血较多术中转开腹处理；阴道残端愈合不良、持续性异位妊娠各2例，子宫穿孔、输尿管损伤、切口感染各1例经保守治疗治愈，无死亡病例。结论严格把握腹腔镜手术的适应证，认真、谨慎开展符合自己水平的手术，提高手术医师的操作技能，必要时中转开腹是减少并发症发生的关键。     

妇科腹腔镜手术腹壁下动脉损伤致失血性休克2例报告

腹腔镜手术并发症包括腹腔镜手术过程中盆腹腔脏器的直接损伤以及手术操作间接引起的并发症如切口疝等,血管损伤是腹腔镜手术较严重的并发症。本文就我院发生的妇科腹腔镜手术腹壁下动脉损伤致失血性休克2例进行回顾性分析,旨在探讨妇科腹腔镜手术腹壁下动脉损伤的预防和处理。1临床资料例1,26岁,因“发现卵巢囊肿4个月”于2004年9月13日入院。入院诊断:左卵巢浆液性囊腺瘤;先天性心脏病,动脉导管未闭,肺动脉高压,心功能Ⅱ级。入院后在全麻下行腹腔镜左卵巢囊肿剔除术。全麻,仰卧位,取脐孔中央小切口10mm进镜,探查,见左侧卵巢冠囊肿。于左右下腹相当于麦氏点连线位置分别以10、5mm trocar穿刺进腹,钝性剥离囊肿。查创面无活动性出血,生理盐水冲洗,拔镜放气。术后1h患者血压87/67mm Hg,脉搏165次/min;术后2h,血压继续降至70/50mm Hg,贫血貌,下腹叩诊有移动性浊音,各穿刺孔敷料清洁干燥。考虑“腹壁下动脉损伤,失血性休克”,急诊行腹腔镜探查术,见左侧穿刺孔处活动性出血,于搏动性出血部位电凝止血,共出血约2000ml。术后1周复查血红蛋白131g/L,拆除腹壁缝线,痊愈出院。术后病理:符合左卵巢冠囊肿...     

老年腹股沟嵌顿疝87例急诊手术疗效分析

目的 探讨老年腹股沟嵌顿疝的急诊手术选择和治疗效果。方法 回顾性分析2015年1月至2017年4月北京朝阳医院急诊手术的87例老年腹股沟嵌顿疝病人资料,分为腹腔镜组（12例）和开放组（75例）,分析病人的临床资料、手术方式选择及并发症发生率等。结果 腹腔镜组12例均行腹腔镜腹股沟疝修补手术;开放组75例病人中,71例行开放腹股沟疝修补术,4例行传统疝修补术。随访时间11（10~14）个月。79例（90.8%）病人完成随访,1例病人死亡。开放组出现肠瘘1例,两组病人均未出现复发、慢性疼痛等并发症。腹腔镜组和开放组的的感染发生率分别为0和5.3%（P=0.000）,血肿发生率分别为0和14.7%（P=0.000）,术后1个月血清肿发生率分别为33.3%（4/12） 和40.3%（27/67）（P=0.012）、术后 3个月血清肿发生率分别为16.7%（2/12）和 31.3%（21/67）（P=0.024）,住院时间分别为5（4~6）d和7（6~10）d（P=0.032）,差异均有统计学意义。结论 老年腹股沟嵌顿疝病人诊断明确后均应行急诊手术,手术策略与手术方式的选择应遵循个体化治疗的理念,尽管腹腔镜手术具有探查腹腔的优势,但应综合评估后慎重选择。     

腹腔镜与开腹结直肠癌根治术围手术期并发症发生率比较

目的 研究腹腔镜与开腹结直肠癌根治术围手术期并发症发生率的差异。方法 前瞻性、非随机对照2000年9月至2005年12月由同一组医师连续实施的214例腹腔镜结直肠癌根治术（腹腔镜手术组）与277例开腹结直肠癌根治术（开腹组）患者术中与术后2周内并发症发生率的差异。结果腹腔镜手术组中转开腹14例（6．5％）。术中腹腔镜手术组与开腹手术组并发症发生率分别为4．8％与3．6％（X^2=0．446，P〉0．05）。腹腔镜手术组出现骶前大出血、肠系膜下动脉根部出血、系膜出血、腹膜后气肿、吻合口破裂、直肠镜检并肠穿孔、阴道损伤及膈肌损伤各1例，直肠残端裂开2例；有7例予以中转开腹处理，术后无并发症出现。开腹手术组出现骶前大出血5例，直肠残端裂开与吻合口破裂各2例，输尿管损伤1例。术后腹腔镜手术组与开腹手术组并发症发生率分别为23．5％与36．8％（X^2=9．598，P〈0．01），其中并发肠梗阻分别为3．5％与6．5％（X^2=2．102，P〉0．05）；吻合口瘘分别为2．0％与3．0％（X^2=0．089，P〉0．05）；吻合口出血分别为5．8％与3．5％（X^2=1．064，P〉0．05）；乳糜瘘分别为1．5％与2．5％（X^2=0．201，P〉0．05）；肺部感染分别为7．0％与9．0％（X^2=0．635，P〉0．05）；切口感染分别为5．5％与14．1％（X^2=4．978，P〈0．05）。结论 腹腔镜结直肠癌根治术中并发症发生率与开腹手术无异，但术后并发症总发生率显著低于开腹手术。     

腹腔镜诊治小儿急腹症769例体会

目的探讨腹腔镜在小儿急腹症中应用的价值。方法对我院2005年1月至2011年1月的769例小儿急腹症行腹腔镜探查术病例资料进行回顾分析。结果术前确诊率86．22％（663／769）。术中确诊率99．74％（767／769）,2例消化道出血未能确诊,转院继续治疗。完全腹腔镜下进行治疗667例,手术时间25～132（37．3±12．6）min,手术成功率87．26％（671／769）。住院3～10d,平均5d。1例过敏性紫癜、2例大网膜血肿、1例肠系膜血肿术中无需进一步手术处理;5例中转开腹（1例脾破裂、2例消化道出血、1例肠系膜裂孔疝并嵌顿、1例慢性阑尾炎急性发作）;93例腹腔镜辅助切口完成手术。735例随访2～60个月,其中1例未能确诊的消化道出血死亡,另1例未能确诊的消化道出血失访。3例出现脐部线头反应,换药取出线头治愈。余病例无并发症发生。结论腹腔镜确诊率较高,有助于使急腹症患者得到及时、合理、有效的治疗。急诊腹腔镜手术不仅可以对腹部病变及时作出诊断和处理,而且可使一些患者避免不必要的剖腹手术。     

腹腔镜经腹入路泌尿系手术的并发症及预防处理

目的：分析腹腔镜经腹入路泌尿系手术并发症的原因及预防和处理方法。方法：回顾分析1156例腹腔镜经腹入路泌尿系手术的资料，总结出现的并发症和处理方法。结果：1156例手术出现严重并发症22例，其中皮下气肿6例；肾上腺手术过程中肾静脉损伤转开放1例，肾上腺中央静脉损伤2例；肾囊肿去顶减压周围肾实质出血2例；根治性肾切出血转开放3例；1例肾切除术后出血再次急诊开放手术发现肾蒂周围一分支小动脉出血。膈肌损伤腔镜下修补2例；胰腺损伤转开放1例；脾脏损伤出血再手术开放脾切除1例；结肠损伤1例；术后肺动脉栓塞2例。本组手术的并发症发生率为1．9％（22／1156），转开放率0．43％（5／1156），再手术率0．35％（4／1156），无死亡病例。22例患者积极正确处理后均痊愈出院。结论：充分认识腹腔镜经腹入路泌尿系手术的常见并发症，提高手术操作技巧，正确预防和处理并发症，可以避免严重后果的发生。     

Hand-assisted laparoscopic sigmoid resection for diverticular disease: 100 consecutive cases

BACKGROUND: Hand-assisted laparoscopic surgery (HALS) has been proposed as a useful alternative to conventional laparoscopic and open surgery. As compared with conventional laparoscopic surgery, it offers the advantages of tactile feedback, better exposure, and a shorter learning curve. There is increasing evidence that HALS retains the advantages of minimal-access surgery. The aim of this study was to analyze the feasibility as well as the short- and medium-term outcomes of HALS sigmoid resection for diverticular disease. METHODS: The study included 100 consecutive patients between July 1999 and August 2004. Data were prospectively recorded. Follow-up evaluation was performed by standardized telephone interview after a mean postoperative period of 19 months (range, 2-55 months). RESULTS: Two major intraoperative complications occurred: splenic laceration requiring splenectomy and ureteral injury requiring suture. There were only three conversions: one case of pararectal incision and two cases of extended lower Pfannestiel incision. There was no single case of conversion to midline laparotomy. One patient died postoperatively of myocardial infarction. The postoperative complications included intraabdominal hematoma (2%), anastomotic leakage (3%), wound infection (11%) and bladder dysfunction (1%). The reoperation rate was 5%. The median hospital stay was 8 days. In terms of satisfaction with the results, 97% of patients would choose HALS again. CONCLUSIONS: When used for diverticular disease, HALS sigmoid resection has a low intra- and postoperative complication rate. The satisfaction rate among patients is high. Even in technically difficult cases, conversion to midline laparotomy can be avoided.     

Operative laparoscopy and vulvar hematoma: an unusual association.

Few cases of intraoperative or postoperative complications associated with laparoscopic adnexal surgery have been reported in the literature. We describe a case of laparoscopic abdominal vascular injury and persistent bleeding in the matrix of the ovary following laparoscopic cystectomy. During the first postsurgical day, the patient was syncopal. The physical examination showed a vulvar hematoma and minimal bleeding from a laparoscopic incision in the abdominal wall. Vulvar hematoma and an unstable patient may signal serious vascular bleeding.     

Optical access trocar injuries in urological laparoscopic surgery

PURPOSE: Inadvertent injuries during trocar and Veress needle placement are a rare but potentially serious complication of laparoscopic surgery. An access alternative is an optical trocar under direct vision. Limited data are available regarding the safety of this technique. We reviewed complications related to optical access trocars during standard transperitoneal urological laparoscopic procedures performed at a single institution. MATERIALS AND METHODS: From 1995 to 2001 the optical access trocar was used as the initial trocar in 1,283 urological laparoscopic procedures. The procedures included simple and radical nephrectomy in 309 cases, donor nephrectomy in 386, partial nephrectomy in 79, pyeloplasty in 173 and various other procedures in 336. Intra-abdominal complications caused by optical access trocar were assessed. RESULTS: The optical trocar was inserted at the umbilicus in 88 patients (7.4%), in the right upper quadrant in 445 (34.7%) and in the left upper quadrant in 750 (58.5%). There were 4 injuries (0.31%) associated with the optical access trocar. Complications occurred on the left side in 3 cases and on the right side in 1, including 1 injury to bowel, 1 mesenteric injury resulting in a retroperitoneal hematoma and 2 injuries to epigastric vessels. Three cases were recognized and repaired immediately but in a case of epigastric vessel injury the expanding abdominal wall hematoma required postoperative repair. CONCLUSIONS: Optical access trocars provide a safe and rapid technique for initial trocar placement. Results of this large series support the finding that few trocar related complications are associated with the optical access trocar.     

Complications of laparoscopic adrenalectomy in 75 patients treated by the same surgeon.

OBJECTIVE: We analyzed the complications of endoscopic adrenalectomy. METHODS: We retrospectively reviewed the operative and postoperative complications among 75 patients with adrenal tumors who underwent endoscopic adrenalectomy by the same surgeon. RESULTS: Five patients (6.7%) were converted to open surgery. Of these, there were 2 with metastatic adrenal carcinoma, and 1 with adrenal tuberculosis. A total of 21 patients (28%) had 24 complications (32%). There was no mortality. As for access and pneumoperitoneum-related complications, 5 cases of subcutaneous emphysema and 3 of radiating shoulder pain occurred. Intraoperative complications included 2 cases of vascular injury, 2 of organ injury, and 4 of massive bleeding (>500 ml). Postoperative complications included 2 cases of mild paralytic ileus, 2 asthma, and 1 each of angina, wound infection, retroperitoneal hematoma, and contralateral atelectasis. Except for the patients with adrenal malignancy and adrenal tuberculosis, 71% of the complications occurred among the initial 25 patients with laparoscopic adrenalectomy and 80% occurred in the initial 10 retroperitoneoscopic patients. CONCLUSION: Although endoscopic adrenalectomy is a valuable alternative to open surgery, it should be done by a skilled laparoscopist in patients with adrenal inflammatory lesions or malignancy. Careful patient selection and correct choice of surgical approach according to the tumor size and the patient's condition are the most important points for avoiding the complications of laparoscopic adrenalectomy.     

腹腔镜内环口缝扎术治疗小儿鞘膜积液

目的:探讨腹腔镜内环口缝扎术治疗鞘膜积液的临床疗效及安全性。方法:2004年7月至2012年1月于气管插管全麻下为1 182例鞘膜积液患儿行腹腔镜内环口缝扎术。其中男1 128例,女54例;单侧957例,双侧225例;交通性鞘膜积液554例,精索鞘膜积液223例,睾丸鞘膜积液405例。其中隐性鞘膜积液383例,复发性鞘膜积液38例。结果:1 182例患儿均顺利完成麻醉和手术,手术时间8～12 min,平均10 min。术中出血少于1 ml,无一例发生麻醉意外、脏器损伤及中转开腹,治愈率99.58%,腹部切口甲级愈合率100%。术后复发5例,切口大网膜疝出3例,阴囊水肿血肿29例;无一例发生切口感染、肠粘连、睾丸萎缩。结论:气管插管全麻腹腔镜内环口缝扎术治疗小儿鞘膜积液具有麻醉安全、组织创伤小、出血少、操作简单、术后康复快、并发症少、安全、美观、有效等优点,可达到治愈目的;适于任何类型的小儿鞘膜积液,值得广泛应用。     

腹腔镜胆囊切除术切口并发症31例报告

目的:探讨腹腔镜胆囊切除术(LC)切口并发症的发生原因、治疗、预防及预后。方法:回顾1 650例LC发生切口并发症31例的临床资料。结果:31例中切口感染12例,切口下积液11例,切口裂开1例,切口出血1例,皮下淤血及血肿1例,切口疝2例,切口肿瘤种植1例,增殖性瘢痕2例。结论:严格的无菌技术,恰当的切口选择,细致和规范的技术操作,良好的麻醉配合和合理的术后处理是预防LC切口并发症的重要措施。     

电视腹腔镜妇科手术68例报告

目的 :探讨腹腔镜治疗妇科疾病的效果。方法 :应用腹腔镜治疗妇科疾病 6 8例并进行临床分析。结果 :6 8例中 1例中转开腹 ,余均在腹腔镜下完成。术中发生腹壁气肿 1例 ,术后并发会阴水肿 1例。结论 :与传统的开腹术相比 ,腹腔镜妇科手术具有切口小、出血少 ,术后恢复快 ,治疗效果确切等优点 ,适宜临床推广。     

Major complications during laparoscopic cholecystectomy

Laparoscopic cholecystectomy may lead to serious complications, some of which can be disastrous if they are not recognized and managed immediately. Over the past 12-year period, 1225 laparoscopic cholecystectomies were performed. Totally, major complications occurred in 19 cases (1.5%). The conversion rate was 7.4%. Complications included common bile duct injury in 2 cases (0.16%), vessel injury by trocar or Veress needle in 4 cases (0.32%) including 1 case of aorta injury (0.08%), bleeding from the gallbladder bed or the cystic artery in 10 cases (0.8%), bile leak in 1 case (0.08%), duodenum injury in 1 case (0.08%), and transient liver ischemia in 1 thalassanemic patient (0.08%). The complication was recognized during the operation in 11 cases. Reoperation was necessary in five cases (0.4%), and conservative management was applied in three cases. Although infrequent, major complications may occur during laparoscopic cholecystectomy. Immediate recognition and management is critical and may lead to a safe outcome.     

腹腔镜结直肠癌根治术56例报告

目的:对比分析腹腔镜结直肠癌根治术与传统根治术的临床疗效.方法:回顾分析2002年1月至2009年12月施行的56例腹腔镜和86例传统结直肠癌根治术的临床资料,对比分析其手术操作、并发症及术后情况等.结果:8例中转开腹,占14.3%.腹腔镜组平均住院时间多于开腹组 [(8.3±1.4)d vs.(5.2±1.6)d]....