腹腔镜手术入路并发症

回顾的腹腔镜进入技术包括经典气腹 (Veress/套管针)、开放式 (Hasson)、直接套管针插入、使用一次性屏蔽套管针、径向扩张套管针和视觉进入系统。有证据表明，微创手术优于传统开放手术，因为这对女性、社区和医疗保健系统有益。在过去的 60 余年里，已经引入了许多技术、技术和指南来消除与腹腔镜进入相关的风险。没有任何一种技术或仪器被证明可以消除与腹腔镜进入相关的伤害。对女性进行适当的评估，辅以手术技巧和对技术和仪器的良好了解，是腹腔镜手术期间安全进入和预防并发症的关键。

在过去的三十 余年中，腹腔镜手术不断发展，现已被公认为解决大多数妇科问题的首选方法。

一项对 27 项随机对照试验的荟萃分析比较了腹腔镜和开腹手术在妇科良性手术中的应用，结果表明，腹腔镜手术后发生轻微并发症的风险比开腹手术低 40%，尽管发生严重并发症的风险相似。

进入腹部是腹腔镜手术的一项挑战，特别是通过小切口插入手术器械。进入腹部会导致胃肠道和主要血管受伤，至少 50% 的这些严重并发症发生在手术开始之前。在过去的 25 年里，并发症发生率一直保持不变。

任何腹腔镜手术的初始阶段，腹部入路和气腹的形成都存在着肠道和血管损伤的重大风险。这些是腹腔镜手术所特有的，在开放手术中很少见。

如果外科医生或患者未能及早发现损伤或未能迅速处理，则会导致发病率和死亡率增加。术后而非术中对这些损伤的识别会增加后遗症的严重程度以及医疗法律责任。

在芬兰，在 70,607 例腹腔镜手术后，国家患者保险协会报告了 256 例并发症。重大并发症的总体发生率为每 1,000 例手术 1.4 例。其中包括每 1,000 例肠道损伤 0.6 例、每 1,000 例泌尿系统损伤 0.3 例和每 1,000 例血管损伤 0.1 例。

在荷兰，一项来自 72 家医院的多中心前瞻性研究显示，肠道损伤和重大并发症的总体发生率为每 1,000 例手术 5.7 例。其中 70% 与主要端口入口有关。腹腔镜入口损伤的总体发生率为每 1,000 例 3.3 例。有 29 例胃肠道损伤（每 1,000 例 1.3 例）和 27 例腹部血管损伤（每 1,000 例 1.05 例）。

为了尽量减少与穿刺相关的损伤，上个世纪引入了几种技术、器械和方法。这些包括 Veress-气腹套管针；经典或封闭式穿刺、开放式（Hasson）技术、无需事先气腹的直接套管针插入、使用屏蔽一次性套管针、光学 Veress 针、光学套管针、径向扩张套管针和无套管针可重复使用的可视通道套管。根据外科医生的培训、经验和偏好（根据区域和跨学科的差异），每种穿刺方法都享有一定程度的普及。

腹腔镜手术入路并发症

通过脐进入时遇到的结构

腹腔镜手术入路并发症

Veress 进入技术和腹内压

腹腔镜手术入路并发症

肥胖患者的 Veress 针角度

腹腔镜手术入路并发症

Hasson 技术

唯一不会遇到并发症的外科医生是不做手术的外科医生。所有手术都有风险。即使是最熟练的医生也可能出现并发症，因此必须及时发现并立即处理这些并发症。

适当培训的重要性和经验的价值显而易见。的目标必须是培训未来的腹腔镜外科医生掌握必要的技能，并鼓励为执行最先进手术的人开发专门设计的奖学金。

当出现并发症时，出色的培训和经验将使这些并发症可以通过腹腔镜进行处理。

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J Gynecol Endosc Surg. 2009 Jan-Jun; 1(1): 4–11.doi: 10.4103/0974-1216.51902