妇科腹腔镜手术中转开腹手术的原因分析

目的探讨妇科腹腔镜手术中转开腹手术的原因及预防措施。方法对2001年1月至2005年12月间,在首都医科大学附属复兴医院和附属北京妇产医院妇科微创诊治中心接受妇科腹腔镜手术的3203例患者的临床资料进行回顾性分析。结果3180例手术在腹腔镜下完成,23例中转开腹手术。中转开腹手术率为0．72％。其中,盆腔严重粘连6例,因病变复杂镜下操作困难7例,术中大出血3例,膀胱损伤1例,胃损伤1例,肠管损伤1例,未预计的恶性肿瘤4例。结论盆腔严重粘连、病变复杂腹腔镜下操作困难为中转开腹手术的主要原因,加强术前评估、严格掌握腹腔镜手术指征、适时中转开腹,可减少并发症发生。

Clinical analysis of conversion from gynecological laparoscopic surgery to laparotomy

OBJECTIVE: To discuss the causes and clinical significance of conversion to laparotomy during laparoscopic surgery. METHOD: Three thousand two hundred and three cases who underwent laparoscopic surgery during the past five years were analyzed retrospectively. RESULTS: Three thousand one hundred and eighty cases underwent laparoscopic surgery, in which 23 cases were converted to laparotomy due to factors including severe pelvic adhesions (6 cases), complex disease with difficulties in laparoscopy (7 cases), massive haemorrhage (3 cases), bladder trauma (1 case), gastric trauma (1 case), intestinal trauma (1 case), as well as unexpected malignant genitalia neoplasm (4 cases). CONCLUSION: The major causes for the conversion to laparotomy during gynecology laparoscopic surgery are severe pelvic adhesion and complex disease with difficulties in laparoscopy. Careful evaluation before surgery and conversion to laparotomy at the right moment can decrease the complication.