腹腔镜下腹膜代阴道成形术并发症14例分析  

Analysis of Complications of Laparoscopic Peritoneal Vaginoplasty: Report of 14 Cases

作　　者：马亚欣 党群[1] 刘慧丽[1] 王秋明[1] 王倩倩 Ma Yaxin;Dang Qun;Liu Huili(Department of Obstetrics and Gynecology,Henan Provincial People’s Hospital,Henan University People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院妇产科河南大学人民医院

出　　处：《中国微创外科杂志》2020年第1期81-84,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：河南省科技发展计划项目(182102310471);河南省医学科技攻关计划项目(201602224);河南省医学科技攻关计划联合共建项目(2018020418)

摘　　要：目的探讨腹腔镜下腹膜代阴道成形术治疗MRKH综合征(Mayer-Rokitansky-Küster-Hauser syndrome)的并发症发生原因、处理方法及预防措施。方法对2012年1月~2018年12月我院腹腔镜腹膜代阴道成形术76例资料进行回顾性分析,发生并发症14例(18.4%)。其中术中膀胱损伤3例(3.9%)、直肠损伤1例(1.3%),均及时发现并修补;术后并发症10例(13.2%),分别为感染1例、阴道出血2例、大网膜及输卵管伞部脱出1例、阴道顶端息肉3例、阴道外口狭窄1例及阴道挛缩2例,均对症处理。结果术中膀胱、直肠损伤均修补成功,术后并发症均保守治疗成功。术后随访1~2年,中位数1年,无不适,妇科检查正常。结论并发症的发生原因主要是既往手术史造成局部粘连、手术技巧及术后患者放置模具的依从性,要求术者熟练掌握操作技巧,提高对复杂情况的应对能力,同时要加强对患者出院后的随访管理。Objective To investigate the causes,treatment methods and preventive measures of complication of laparoscopic peritoneal vaginoplasty in the treatment of Mayer-Rokitansky-Küster-Hauser syndrome(MRKH syndrome).Methods Clinical data of 76 patients who underwent laparoscopic peritoneal vaginoplasty in our hospital from January 2012 to December 2018 were analyzed retrospectively.There were 14 complications(18.4%).Three cases(3.9%)of bladder injury and 1 case(1.3%)of rectum injury were found and repaired in time.Postoperative complications were found in 10 cases(13.2%),including infection(1 case),vaginal bleeding(2 cases),omentum and fimbria prolapse(1 case),polyp at the top of the vagina(3 cases),stenosis of the external orifice of the vagina(1 case)and vaginal contracture(2 cases),all of which were treated symptomatically.Results Intraoperative bladder and rectal injury were successfully repaired,and postoperative complications were conservatively treated.The patients were followed up for 1-2 years(median,1 year).There was no discomfort,and the gynecological examination was normal.Conclusions The main causes of complications are local adhesions caused by the past surgical history,surgical skills and the patients’compliance with the post-operative mold placement,which requires the operators to master the operation skills and the ability to deal with the complicated situation during the operation.Moreover,the follow-up management after discharge should be strengthened.

关 键 词：腹腔镜手术 MRKH综合征 并发症 腹膜 阴道成形术 

分 类 号：R47[医药卫生—护理学]