CAJ | 학술논문

目的：探讨腹腔镜胃癌根治术中医源性脏器损伤的原因。方法对我院2009年9月~2013年4月接受腹腔镜胃癌根治性手术368例进行临床分析。结果发生医源性脏器损伤30例（8.15%），其中22例（22%）发生于早期的100例腹腔镜手术中。脾撕裂伤9例；小肠系膜血肿3例；肝脏挫伤6例；胰腺损伤3例；横结肠系膜损伤4例；横结肠损伤5例。1例横结肠系膜损伤致结肠缺血行结肠部分切除术，1例脾撕裂出血，中转开腹切脾，余所有病例均腹腔镜下或辅助小切口下处理。30例患者均治愈出院。结论腹腔镜胃癌根治术中医源性脏器损伤多发生在腔镜手术早期，与操作不当、暴露不清晰、团队配合不佳、腔镜下解剖入路不熟悉有关。
목적：탐토복강경위암근치술중의원성장기손상적원인。방법대아원2009년9월~2013년4월접수복강경위암근치성수술368례진행림상분석。결과발생의원성장기손상30례（8.15%），기중22례（22%）발생우조기적100례복강경수술중。비시렬상9례；소장계막혈종3례；간장좌상6례；이선손상3례；횡결장계막손상4례；횡결장손상5례。1례횡결장계막손상치결장결혈행결장부분절제술，1례비시렬출혈，중전개복절비，여소유병례균복강경하혹보조소절구하처리。30례환자균치유출원。결론복강경위암근치술중의원성장기손상다발생재강경수술조기，여조작불당、폭로불청석、단대배합불가、강경하해부입로불숙실유관。
Objective To analyze the cause of Iatrogenic injury of organs in laparoscopic procedure for patients with gastric cancer. Methods From september 2009 to april 2013,368 patients with gastric cancer received laparoscopic radical gastrectomy. Rusults Among the cases,30 patients (8.15%) developed Iatrogenic injury of organs,and 22 patients occurs at the early stage of laparoscopic radical gastrectomy.In the 30 patients, 9 patients developed laceration of the spleen;3 patients developed smal mesenteric hematoma;6 patients developed hepatic laceration;3 patients developed pancreatic injury;4 patients developed transverse mesocolon injury;5 patients developed transverse colon injury.one patient with transverse mesocolon injury received partial transverse colectomy because of Colonic ischemia; One patient with laceration of the spleen received Splenectomy from laparoscopy to laparotomy;the other patients dealt with the injury in the laparotomy or using the assisted smal incision.al of the patients were cured. Conclusion Iatrogenic injury of organs often occurs at the early stage of laparoscopic radical gastrectomy. Improper operation、insuf icient exposure of the operational field、a pool team and unfamiliar with the surgical plane in laparoscopic surgery are ralated to the injury.