切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (02) : 121 -124. doi: 10.3877/cma.j.issn.1674-3253.2019.02.012

所属专题: 文献

临床研究

泌尿外科经腹腹腔镜腹壁穿刺血管损伤的临床分析
王刚1, 程庆1, 张冲1, 刘振湘1, 白志明1,()   
  1. 1. 570208 海南,中南大学湘雅医学院附属海口医院泌尿外科
  • 收稿日期:2018-01-17 出版日期:2019-04-01
  • 通信作者: 白志明

Clinical analysis of vascular injury induced by abdominal wall puncture under abdominal laparoscope

Gang Wang1, Qing Cheng1, Chong Zhang1, Zhenxiang Liu1, Zhiming Bai1,()   

  1. 1. Department of Urology, Haikou Hospital Affiliated Xiangya School of Medcine, Central South Uniersity, Hainan 570208, China
  • Received:2018-01-17 Published:2019-04-01
  • Corresponding author: Zhiming Bai
  • About author:
    Corresponding author: Bai Zhiming, Email:
引用本文:

王刚, 程庆, 张冲, 刘振湘, 白志明. 泌尿外科经腹腹腔镜腹壁穿刺血管损伤的临床分析[J]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(02): 121-124.

Gang Wang, Qing Cheng, Chong Zhang, Zhenxiang Liu, Zhiming Bai. Clinical analysis of vascular injury induced by abdominal wall puncture under abdominal laparoscope[J]. Chinese Journal of Endourology(Electronic Edition), 2019, 13(02): 121-124.

目的

探讨泌尿外科经腹腹腔镜腹壁穿刺过程发生血管损伤的原因、处理及预防措施。

方法

回顾分析我院泌尿外科2012年9月至2017年9月间1 025例经腹腹腔镜手术腹壁穿刺过程出现的6例血管损伤患者的临床资料,分析其原因,总结处理及预防措施。

结果

共发生血管损伤6例,其中腹主动脉损伤1例,右髂总动脉损伤1例,腹壁下血管损伤4例,肠系膜动脉损伤1例,其发生率为0.585%(6/1 025)。4例腹腔镜下止血成功,2例中转开放手术止血。

结论

腹腔镜腹壁穿刺导致血管损伤由多种原因引起,腹腔粘连、过度消瘦或肥胖是血管损伤发生的危险因素,需术前个体化评估;对腹部血管解剖的深入理解和术中规范操作是减少其发生的关键;掌握血管损伤的临床表现和处理方法,才能降低对患者的创伤及后遗症。

Objective

To investigate the causes, management and preventive measures of vascular injury induced by abdominal wall puncture under abdominal laparoscope in Department of Urology Surgery.

Methods

Clinical data of 6 of 1025 patients presenting with vascular injury induced by abdominal wall puncture during abdominal laparoscopic surgery from September 2012 to September 2017 in Department of Urology Surgery of our hospital were retrospectively analyzed. The causes were analyzed, and the management and preventive measures were summarized.

Results

Six cases of vascular injury occurred including 1 case of abdominal aorta injury, 1 case of right common iliac arterial injury, 4 cases of inferior abdominal wall vascular injury and 1 case of mesenteric arterial injury. The incidence rate of vascular injury was 0.585% (6/1025). Hemostasis was successfully performed under laparoscope in4 patients and 2 cases were switched to open surgery for hemostasis.

Conclusion

The vascular injury during laparoscopic abdominal wall puncture can be caused by multiple risk factors, such as abdominal adhesion, emaciation or obesity. Individualized evaluation should be delivered before operation. Deep understanding of abdominal vascular anatomy and standardized intraoperative procedures plays a pivotal role in reducing the risk of vascular injury. Mastering the clinical manifestations and effective management of vascular injury can mitigate the trauma and sequela to patients.

[1]
Schäfer M,Lauper M,Krähenbühl L.Trocar and Veress needle injuries during laparoscopy[J]. Surg Endosc, 2001, 15(3): 275-280.
[2]
Krishnakumar S,Tambe P. Entry complications in laparoscopic surgery[J]. J Gynecol Endosc Surg, 2009, 1(1): 4-11.
[3]
Azevedo JL,Azevedo OC,Miyahira SA, et al.Injuries caused by veress needle insertion for creation of pneumoperitoneum: a systematic literature review[J]. Surg Endosc, 2009, 23(7): 1428-1432.
[4]
Catarci M,Carlini M,Gentileschi P, et al. Major and minor injuries during the creation of pneumoperitoneum. A multicenter study on 12919 cases[J]. Surg Endosc, 2001, 15(6): 566-669.
[5]
Bhoyrul S,Vierra MA,Nezhat CR, et al. Trocar injuries in laparoscopic surgery[J]. J Am Coll Surg, 2001, 192(6): 677-683.
[6]
Rafii A,Camatte S,Lelièvre L, et al. Previous abdominal surgery and closed entry for gynaecological laparoscopy: a prospective study[J]. BJOG, 2005, 112(1): 100-102.
[7]
Ambardar S,Cabot J,Cekic V, et al.Abdominal wall dimensions and umbilical position vary widely with BMI and should be taken into account when choosing port location[J]. Surg Endosc, 2009, 23(9): 1995-2000.
[8]
Hammond I. Atlas of Pelvic Anatomy and Gynecologic Surgery, 3rd Edition[J]. ANZ Journal of Surgery, 2011, 81(12): 939-940.
[9]
Wong C,Merkur H. Inferior epigastric artery: Surface anatomy, prevention and management of injury. [J]Aust N Z J Obstet Gynaecol, 2016, 56(2): 137-141.
[10]
Joy P,Prithishkumar IJ,Isaac B.Clinical anatomy of the inferior epigastric artery with special relevance to invasive procedures of the anterior abdominal wall[J]. J Minim Access Surg, 2017, 13(1): 18-21.
[11]
Tinelli A,Gasbarro N,Lupo P, et al. Safe introduction of ancillary trocars[J]. JSLS, 2012, 16(2): 276-279.
[12]
Welsh F,Singh S. Abdominal access techniques (including laparoscopic access)[J]. Surgery (Oxford), 2006, 24(7): 229-233.
[13]
Madan AK,Taddeucci RJ,Harper JL, et al. Initial Trocar Placement and Abdominal Insufflation in Laparoscopic Bariatric Surgery[J]. J Surg Res, 2008, 148(2): 210-213.
[14]
Taye MK,Fazal SA,Pegu D, et al.Open Versus Closed Laparoscopy: Yet an Unresolved Controversy[J]. J Clin Diagn Res, 2016, 10(2): 4-7.
[15]
Rabl C,Palazzo F,Aoki H, et al. Initial laparoscopic access using an optical trocar without pneumoperitoneum is safe and effective in the morbidly obese[J]. Surg Innov, 2008, 15(2): 126-131.
[16]
Ahmad G,Gent D,Henderson D, et al. Laparoscopic entry techniques[J]. Cochrane Database Syst Rev, 2015, 8: CD006583.
[17]
Li TC,Saravelos H,Richmond M, et al. Complications of laparoscopic pelvic surgery: recognition, management and prevention[J]. Hum Reprod Update, 1997, 3(5): 505-515.
[18]
Sobkin PR,Bloom AI,Wilson MW,et al.Massive abdominal wall hemorrhage from injury to the inferior epigastric artery:a retrospective review[J]. J Vasc Interv Radiol, 2008, 19(3): 327-332.
[19]
Seidman DS,Nasserbakht F,Nezhat F, et al. Delayed recognition of iliac artery injury during laparscopic surgery[J]. Surg Endosc, 1996, 10(11): 1099-1101.
[20]
李静,赵珊珊,李蕾. 罗库溴铵致过敏性休克1例[J]. 中国医院药学杂志,2013,33(5): 423-424.
[1] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[2] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[3] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[4] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[5] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[6] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[7] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[8] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[9] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[10] 唐健雄, 李绍杰. 不断推进中国腹腔镜疝手术规范化[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 591-594.
[11] 马涛, 叶春伟, 刘滔, 彭文希, 李志鹏. 腹腔镜与开放性离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 605-610.
[12] 刘成, 赖聪, 黄健, 王建辰, 罗茜芸, 许可慰. EDGE SP1000单孔手术机器人辅助腹腔镜下猪输尿管部分切除联合端端吻合术的可行性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 642-646.
[13] 叶晋生, 路夷平, 梁燕凯, 于淼, 冀祯, 贺志坚, 张洪海, 王洁. 腹腔镜下应用生物补片修补直肠术后盆底缺损的疗效[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 688-691.
[14] 夏松, 姚嗣会, 汪勇刚. 经腹腹膜前与疝环充填式疝修补术治疗腹股沟疝的对照研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 702-705.
[15] 李博, 胡刚, 邱文龙, 汤坚强, 王锡山. 多功能吲哚菁绿近红外荧光血管成像技术在腹腔镜直肠癌经自然腔道取标本手术(NOSES Ⅳ式)中的应用(附视频)[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 524-528.
阅读次数
全文


摘要