泌尿外科经腹腹腔镜腹壁穿刺血管损伤的临床分析
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摘要
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 September2017 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 in 4 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.
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 September2017 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 in 4 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.
引文
[1]Sch?fer M,Lauper M,Kr?henbühl 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 on12919 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.
[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 on12919 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.