1557例妇科腹腔镜手术并发症发生情况及相关因素分析

目的探讨妇科腹腔镜手术并发症发生情况及相关影响因素,寻求有效预防和减少并发症的方法,降低并发症的危害。方法对巫山县人民医院2010年1月-2013年7月间共1 557例腹腔镜手术术中及术后并发症的发生情况进行回顾性分析。结果 1 557例妇科腹腔镜手术中,出现术中或术后并发症者共29例,发生率为1.86%;其中附件手术1 002例,出现并发症9例(0.89%),子宫肌瘤剔除术253例,并发症1例(0.39%),LAVH术130例中发生并发症共12例(9.23%),子宫次全切除术148例中出现并发症6例(4.05%),其他手术24例中有1例出现并发症(4.16%)。其中行LAVH的并发症发生率与子宫次全切除术的相当(P0.05),且两者的发生率显著高于附件手术,子宫肌瘤剔除术及其他手术(P0.05);手术并发症与医师的手术经验明显相关,手术经验不足3年者,并发症及开腹中转率明显升高(χ2并发症发生率=81.09、χ2开腹中转率=13.97,P均0.05);手术并发症与腹部手术史有相关性,有腹部手术史患者并发症发生率(3.73%)较无手术史者(1.52%)增高(χ2=5.47,P0.05)。结论提高医生手术水平,严格把握手术适应症,进行手术分级管理,并适时中转开腹,同时加强团队合作建设,才能降低各种并发症。

Analysis on the incidence and risk factors of complications with gynecologic laparoscopic surgery

Abstract： Objective To study the incidence and related risk factors for operative complications after gynecologic laparoseopic procedures. To seek the effective way for preventing and declining the complications so as to reduce the harm of complications. Methods We retrc,spectively analyzed the incidence of intraoperative and postoperative complications of gynecologic laparoscopic surgery on 1,557 patients hospitalized in the People＇s Hospital of Wushan County between January 2010 to July 2013. Results The overall incidence of intraoperative and tx~stoperative complications was 1.86 % （29/1,557）, of which the incidence of com- plications in gynecological adnexal operation, myomectgmy, laparoscopically assisted vaginal hysterectomy （LAVH）, hysterectomy and other surgeries was 0.89% （9/1,002）, 0.39% （1/253）, 9.23% （12/130）, 4.05% （6/148） and 4.16% （1/24） respective- ly. The incidence of complications in LAVH was similar to that of hysterectomy （P 〉 0.05）, moreover, the complication inci- dence was significantly higher in the above - mentioned two surgeries than in gynecological adnexal operation, myomectomy and other surgeries （P 〈 0.05）. The incidence of operative complications was clearly correlated with gynecologists＇ surgical experi- ence. The higher complications and conversions to laparotomy were observed among gynecologists with less than 3 years of laparo-scopic experience（X^2complication incidence= 81. 09,X^2 conversion laparotomy=13.97,both P〈0.05）.There was a correlation between operativecomplications and history of abdominal surgery, moreover, the incidence of complications was higher in patients with history of ab- dominal surgery （3.73 % ） than in those without the history （1.52 % ）, （ X^2=5.47, P 〈 0.05）. Conclusion Improving sur- gical skills, strictly controlling surgical indications, conducting surgical hierarchical management, timely converting to laparotomy and simultaneously strengthening team building are helpful for reducing v