泌尿外科经腹腹腔镜腹壁穿刺血管损伤的临床分析

目的探讨泌尿外科经腹腹腔镜腹壁穿刺过程发生血管损伤的原因、处理及预防措施。 方法回顾分析我院泌尿外科2012年9月至2017年9月间1 025例经腹腹腔镜手术腹壁穿刺过程出现的6例血管损伤患者的临床资料，分析其原因，总结处理及预防措施。 结果共发生血管损伤6例，其中腹主动脉损伤1例，右髂总动脉损伤1例，腹壁下血管损伤4例，肠系膜动脉损伤1例，其发生率为0.585%（6/1 025）。4例腹腔镜下止血成功，2例中转开放手术止血。 结论腹腔镜腹壁穿刺导致血管损伤由多种原因引起，腹腔粘连、过度消瘦或肥胖是血管损伤发生的危险因素，需术前个体化评估；对腹部血管解剖的深入理解和术中规范操作是减少其发生的关键；掌握血管损伤的临床表现和处理方法，才能降低对患者的创伤及后遗症。

Clinical analysis of vascular injury induced by abdominal wall puncture under abdominal laparoscope

ObjectiveTo investigate the causes, management and preventive measures of vascular injury induced by abdominal wall puncture under abdominal laparoscope in Department of Urology Surgery. MethodsClinical data of 6 of 1025 patients presenting with vascular injury induced by abdominal wall puncture during abdominal laparoscopic surgery from September 2012 to September 2017 in Department of Urology Surgery of our hospital were retrospectively analyzed. The causes were analyzed, and the management and preventive measures were summarized. ResultsSix cases of vascular injury occurred including 1 case of abdominal aorta injury, 1 case of right common iliac arterial injury, 4 cases of inferior abdominal wall vascular injury and 1 case of mesenteric arterial injury. The incidence rate of vascular injury was 0.585% (6/1025). Hemostasis was successfully performed under laparoscope in4 patients and 2 cases were switched to open surgery for hemostasis. ConclusionThe vascular injury during laparoscopic abdominal wall puncture can be caused by multiple risk factors, such as abdominal adhesion, emaciation or obesity. Individualized evaluation should be delivered before operation. Deep understanding of abdominal vascular anatomy and standardized intraoperative procedures plays a pivotal role in reducing the risk of vascular injury. Mastering the clinical manifestations and effective management of vascular injury can mitigate the trauma and sequela to patients.