腹腔镜辅助阴式子宫切除术并发脏器损伤

目的探讨腹腔镜辅助阴式子宫切除术（laparoscopic assisted vaginal hysterectomy,LAVH）脏器损伤的原因及处理。方法 2009年3月～2010年12月我院行317例LAVH,7例发生脏器损伤。腹腔镜下处理附件后,经阴道缝扎子宫血管、主骶韧带及缝合阴道残端。结果脏器损伤7例,发生率2.2%（7/317）：膀胱损伤3例,直肠损伤2例,输尿管损伤2例。3例膀胱损伤术中行修补术,术后留置导尿2周拔管。2例直肠损伤术中行破口修补缝合,术后流质饮食,排便后正常饮食。2例输尿管损伤,1例术中行输尿管断端缝合术并放置双J管,1例术后25 d开腹探查行输尿管膀胱植入放置双J管治愈。7例术后随访1～3个月,愈合良好,无并发症发生。结论 LAVH并发周围器官损伤与手术难度及手术操作有关。加强手术医师技巧培训及术前评估、注意术后观察,有利于减少并发症、及时发现病情变化。

Organ Injury Caused by Laparoscopic-assisted Vaginal Hysterectomy

Objective To investigate the causes and management of organ injury during laparoscopic-assisted vaginal hysterectomy （LAVH）. Methods From March 2009 to December 2010, we performed LAVH on 317 patients, 7 of them developed organ injury. After the uterine adnexa were handled with laparoscopy, we performed transvaginal ligation of the uterine vessels, cardinal and utero-sacral ligaments, and then closed the vaginal stump. Results The incidence rate of organ injury during LAVH was 2.2% （7/317）. In the 7 cases, 3 had bladder injury, 2 had rectal injury, and the other two had ureteral injury. The 3 patients, who had bladder injury, received intra-LAVH repair, and then postoperative catheterization for 2 weeks. The rectal rupture was sutured during the LAVH, and the patients received liquid diet until normal defecation was recovered. And in the two patients with ureteral injury, ureteral stump suturing plus double-J catheterization were carried out in one of them, the other one received open surgery for intra-abdominal exploration, implantation of the ureter and bladder, and then double-J catheterization. All the 7 patients recovered well after the surgery, and no complications occurred in a 3-month follow-up. Conclusions Organ injury caused by LVAH is related to the difficulty of the procedure and the operation skills. Consolidated surgical training, preoperative evaluation, and postoperative observation are important for preventing complications.