泌尿外科传统腹腔镜手术严重并发症的分析(附2800例报告)

摘要

目的:总结泌尿外科传统腹腔镜手术的严重并发症,分析其类型、原因、发病率、治疗措施及预后,以提高手术安全性.方法:回顾分析1999年10月至2011年3月施行2 800例泌尿外科传统腹腔镜手术的临床资料.总结与腹腔镜操作相关的严重并发症,分析与穿刺、气腹、术中操作及术后相关并发痘的发生原因、处理对策.结果:2 800例手术中79例发生与腹腔镜手术相关的严重并发症,发生率2.82％.大血管损伤27例,占34.18％,其中13例中转开放或二次手术,14例于腹腔镜术中成功处理.重要脏器损伤5例,占6.33％,包括肠管损伤4例和胰腺尾部损伤l例.所有严重并发症中,中转开放或二次手术共22例,占27.85％.发生严重并发症的患者平均住院(15.1±4.6)d,其他患者平均住院(7.3±3.2)d,两者差异有统计学意义(P＜0.05).结论:腹腔镜操作造成的并发症有其自身特点.随着腹腔镜术者技术水平的提高,腹膜后大血管损伤等严重并发症已能在腹腔镜下恰当处理,从而避免了中转开放或二次手术.为避免腹腔镜相关并发症的发生,泌尿外科医师需按循序渐进的原则.完善的术前准备、正确的手术操作及细致的术后管理对预防并发症的发生至关重要.%Objective:To summarize the severe complications relevant to traditional laparoscopic surgery of urology and to analyze the categories,causes,incidence,treatments and prognosis of such complications,so as to improve the safety of laparoscopic operations. Methods:From Oct. 1999 to Mar. 2011,2 800 traditional laparoscopic operations of urology were accomplished. The causes and therapeutic managements of serious complications were analyzed, including complications referring to the placement of Trocars, pneumo-peritoneum, operation manipulations and postoperative complications. Results: There were 79 cases of severe complications, the incidence of which was 2.82%. 27 cases of great vessels trauma occurred among all operations, the proportion was 34. 18%. In fact ,13 patients were converted to open surgery or secondary surgery because of vascular trauma, and the other vascular injuries were handled successfully during laparoscopic surgery. 5 complications referring to serious visceral injury happened in all,the proportion was 6.33% .including 4 cases of intestinal injury and 1 case of pancreatic tail injury. 22 operations (27.85% of all operations with severe complications) were converted to open surgery or taken into secondary operation because of severe complications. The mean hospital stay of patients who experienced severe complications was (15. 1 ±4.6) d,which was significantly longer than the time of other patients [ (7.3 ±3.2) d,P<0.05]. Conclusions:The complications about laparoscopic surgery have their own characteristics. With the improvement of laparoscopic techniques,serious complications such as retroperitoneal great-vessel injury sometimes can be handled successfully during laparoscopic environment, which can prevent patients from being converted to open surgery or being taken into secondary operations. Urologists must follow "step by step" principle and think highly of perioperative administration in order to avoid various complications relevant to laparoscopic surgery.