泌尿系腹腔镜手术并发症及其防治

目的：探讨泌尿系腹腔镜手术并发症的原因及防治措施方法：回顾性分析2003年9月～2007年9月间行经腹腔镜和经后腹腔镜泌尿系手术的883例患者临床资料，其中经腹腔组74例，经后腹腔组809例，并对其临床诊断、手术方式、手术路径、手术时间、并发症发生率、术后住院时间等情况进行统计学比较分析。结果：883例患者中，出现并发症85例，占9．6％，无死亡病例，其中经腹腔组出现并发症8例（10．8％），经后腹腔组出现并发症77例（9．5％），组间比较差异无统计学意义（P〉0．05）。经腹腔组平均手术时间（121±46）min，经后腹腔组平均手术时间（82±72）min，组间比较差异有统计学意义（P〈0．01）。经腹腔组平均术后住院时间（6．5±3．1）天，经后腹腔组平均术后住院时间（5．8±2．2）天，组间比较差异有统计学意义（P〈0．05）。按2003、2004、2005、2006、2007年度划分，手术并发症发生率分别为31．2％（10／32）、11％（16／145）、7．9％（20／252）、8．3％（22／265）、9．5％（17／]89），组间比较差异有统计学意义（P〈0．01）。结论：经腹腔和经后腹腔镜手术并发症发生率无明显差异，经腹腔路径的平均手术时间、平均术后住院时间均长于经后腹腔路径，腹腔镜手术并发症总体发生率随手术开展时间的延长而降低。通过熟悉并发症的特点，采取妥善的应对措施，可以有效减少泌尿系后腹腔镜手术并发症的发生。

The Prevention and Treatment of Urological Laparoscopy Complications

Objective： To evaluate the causes, prevention and treatment of complications in urological laparoscopy. Methods： From Sep 2003 to Sep 2007, 883 cases of urologic laparoscopies were performed.. 74 cases of transperitoneal laparoscopy while 809 cases of retroperitoneal laparoscopy. Data including each patient＇s diagnosis, type of surgery （transperitoneal or retroperitoneal laparoscopy）, operation time, complications and in-patient day after operation were retrospectively reviewed and clinically analyzed. Results.. Complications appeared on 85 of 883 （9.6%） cases while no patient died. Complications appeared on 8 of 74 cases （10.8 % ） of transperitoneal laparoscopy while 77 of 809 （9.5%） cases of retroperitoneal laparoscopy. The difference between groups was not statistical significant（P〉0.05）. The average operation time was 121± 46 minutes for transperitoneal laparoscopy and 82 ± 7 minutes for retroperitoneal laparoscopy. The difference between groups was statistical significant（P〈0. 01）. The average in-patient day after operation was 6.5±3.1 days for transperitoneal laparoscopy and 5.8±2.2 days for retroperitoneal laparoscopy. There was statistic difference between transperitoneal laparoscopy and retroperitoneal laparoscopy on the rate of complications（P〈0.05）. Divided by 2003,2004,2005,2006,2007, surgical complication rates were 31.2%（10/32）, 11%（16/145）, 7.9%（20/252）, 8.3%（22/265）, 9 . 5%（17/189）, the difference was statistically significant （P〈0.01）. Conclusions.. ：There was no statistic difference between transperitoneal laparoscopy and retroperitoneal laparoscopy on the occurrence of complications. Transperitoneal laparoscopy took more time on operation than retroperitoneal laparoscopy. The average time in hospital after surgery of transperitoneal laparoscopy was longer than retroperitoneal laparoscopy. The rate of complications of laparoscopic surgery de- creased with the passage of time.