腹腔镜经腹入路泌尿系手术的并发症及预防处理  

Complications and Preventive Treatment of Transperitoneal Laparoscope in Urology

作　　者：张雪培[1] 刁长会[1] 魏金星[1] 张卫星[1] 王智勇[1] 任选义[1] 赵刚勇[1] 

机构地区：[1]郑州大学第一附属医院泌尿外科,郑州450052

出　　处：《临床泌尿外科杂志》2009年第5期343-345,共3页Journal of Clinical Urology

摘　　要：目的:分析腹腔镜经腹入路泌尿系手术并发症的原因及预防和处理方法。方法:回顾分析1156例腹腔镜经腹入路泌尿系手术的资料,总结出现的并发症和处理方法。结果:1156例手术出现严重并发症22例,其中皮下气肿6例;肾上腺手术过程中肾静脉损伤转开放1例,肾上腺中央静脉损伤2例;肾囊肿去顶减压周围肾实质出血2例;根治性肾切出血转开放3例;1例肾切除术后出血再次急诊开放手术发现肾蒂周围一分支小动脉出血。膈肌损伤腔镜下修补2例;胰腺损伤转开放1例;脾脏损伤出血再手术开放脾切除1例;结肠损伤1例;术后肺动脉栓塞2例。本组手术的并发症发生率为1.9%(22/1156),转开放率0.43%(5/1156),再手术率0.35%(4/1156),无死亡病例。22例患者积极正确处理后均痊愈出院。结论:充分认识腹腔镜经腹入路泌尿系手术的常见并发症,提高手术操作技巧,正确预防和处理并发症,可以避免严重后果的发生。Objective：To analyze the cause of complications of transperitoneal laparoscopic technique in urology and the preventive treatment. Methods： Analysed retrospectively the 1 156 cases of transperitoneal laparoscopic surgery, the cause and preventive treatment of the complications were analysed. Results： There were 22 patients with serious complications in this group. There were emphysema of the skin （6 cases）; during the transperitoneal adrenal surgery, renal vein trauma with conversion to the open surgery （1 case）, adrenal central vein trauma （2 cases） ; during the cyst of kidney surgery, bleeding from surrounding renal parenchyma （2 cases） ; during the nephrectomy, serious bleeding with conversion to the open surgery （3 cases）; after the nephrectomy, postoperative nephrectomy bleeding with the emergency open surgery,a small branch artery around the renal pedicle was found bleeding （1 case）. Diaphragma rupture repaired under laparoscope （2 cases）; pancreas trauma with conversion to open surgery （1 case）; spleen trauma bleeding which need the splenectomy （1 case）; descending colon injury（1 case）; postoperative pulmonary embolism （2 cases）. The incidence of surgical complications wasl. 9% （22/1 156）, the rate of conversion to the open surgery was 0.43% （5/1 156）, re-operation rate was 0. 35% （4/1 156）. All the 21 patients were got well and healthy when discharged. Conclusions： Take more attention to the complications of transperitoneal laparoscope, elevate the skills of operative procedure, and prevent and management the complications correctly. Those can avoid the serious consequence.

关 键 词：腹腔镜 经腹 泌尿系 并发症 

分 类 号：R699.2[医药卫生—泌尿科学]