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腹腔镜手术的并发症

Authors
Aurora Pryor, MD
William J Mann, Jr, MD
Gerald Gracia, MD
Section Editors
Jeffrey Marks, MD
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
张玉石, 副主任医师

引言

与腹腔镜手术特定相关的严重并发症的发生率整体较低。多达半数的并发症发生在腹腔入路置入镜头或套管时[1]。并发症也可由腹腔注气、组织分离以及止血引起[2]。术中发现的并发症可能需要转为开放式手术处理，但其他并发症可能直到术后才会被发现。严重并发症(例如，血管损伤、肠穿孔)可以是灾难性的，并且是腹腔镜手术相关的操作特异性不良结局和死亡的主要原因。

讨论腹腔镜手术相关并发症的大量文献来自妇科文献，妇科文献提供了对这些损伤最为全面的研究[3]。据推测这些研究的结果可以推广至其他腹腔和腹膜后手术中，但是在任何可能的情况下，妇科、普通外科以及泌尿外科的腹腔镜手术结局应有所区别。

腹腔镜手术特有的手术并发症将在此讨论。手术技术及其具体并发症将在单个专题中讨论。关于腹腔镜手术的其他一般问题(包括腹腔入路、器械)见其他专题。 (参见“腹腔镜手术中应用的进腹技术”和“腹腔镜手术中使用的器械和设备”和“妇科腹腔镜手术和非脐部穿刺点概述”和“Overview of laparoscopy in children and adolescents”)

流行病学和危险因素

与腹腔镜手术特定相关的并发症发生率整体较低。不到1%的患者在最初腹腔入路时出现并发症[4-7]。一旦腹腔入路建立，则术中并发症同样少见；然而，多达6%的患者可出现迟发性套管处疝。具体腹腔镜手术的具体并发症率将在下文章节更为详尽地讨论。下述研究阐述了典型发现：

●一项研究报道了1980-1999年间腹腔入路损伤的索赔结果和上报至美国食品药品监督管理局(Food and Drug Administration, FDA)的医疗器械[8]。腹腔入路损伤的发生率为5-30/10,000例手术。肠和腹膜后血管损伤占到所有损伤的76%，几乎50%的小肠或大肠损伤至少延迟24小时才被发现。腹腔通路建立过程中器官损伤的类型和比例如下：

                     

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-07.
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