CAJ | 학술논문

目的探讨泌尿外科腹腔镜手术中大血管损伤的原因、处理流程及预防原则. 方法回顾性分析2007年1月至2011年7月1700例腹腔镜手术中6例大血管损伤患者资料.均为男性,年龄(53±14)岁.手术经腹膜外途径4例,经腹腔途径2例.其中嗜铬细胞瘤切除术2例,肾上腺瘤切除术、膀胱癌根治术、前列腺癌根治术、右肾盂癌根治术各1例.术中发生下腔静脉损伤2例,髂静脉损伤2例,肾静脉损伤1例,中央静脉损伤1例.血管损伤范围(0.68±0.29)cm,出血量(114±79)ml. 结果 5例采用腹腔镜下修复,使用吸引器压迫止血、分离血管、建立额外套管通道、修补血管处理.其中血管缝合修补4例,使用钛夹夹闭血管1例.修复时间(21.0±5.6) min.1例巨大嗜铬细胞瘤患者因压迫止血时血压骤升无法处理,转开放手术修复.围手术期监测及术后随访(4±2)个月,未发生延迟出血、血栓、血管狭窄等并发症. 结论淋巴结清扫、局部粘连、使用电源器械均易致腹部大血管损伤.血管损伤可发生于术中任何阶段,腹腔镜下修复效果良好,但要求手术医师具备良好的技术和应变能力.
목적 탐토비뇨외과복강경수술중대혈관손상적원인、처리류정급예방원칙. 방법 회고성분석2007년1월지2011년7월1700례복강경수술중6례대혈관손상환자자료.균위남성,년령(53±14)세.수술경복막외도경4례,경복강도경2례.기중기락세포류절제술2례,신상선류절제술、방광암근치술、전렬선암근치술、우신우암근치술각1례.술중발생하강정맥손상2례,가정맥손상2례,신정맥손상1례,중앙정맥손상1례.혈관손상범위(0.68±0.29)cm,출혈량(114±79)ml. 결과 5례채용복강경하수복,사용흡인기압박지혈、분리혈관、건립액외투관통도、수보혈관처리.기중혈관봉합수보4례,사용태협협폐혈관1례.수복시간(21.0±5.6) min.1례거대기락세포류환자인압박지혈시혈압취승무법처리,전개방수술수복.위수술기감측급술후수방(4±2)개월,미발생연지출혈、혈전、혈관협착등병발증. 결론 림파결청소、국부점련、사용전원기계균역치복부대혈관손상.혈관손상가발생우술중임하계단,복강경하수복효과량호,단요구수술의사구비량호적기술화응변능력.
Objective To explore the causes,management and prevention of major blood vessel injury during urological laparoscopic surgery.Methods Six cases of major blood vessel injuries happened in 1700 laparoscopic surgeries from January 2007 to July 2011.All of the cases were males.Patient age was (53 ± 14) years.There were 4 extraperitoneal and 2 transperitoneal procedures including 3 adrenalectomies,1 radical cystectomy,1 radical prostatectomy and 1 radical nephrectomy.There were lacerations in 3 cases of vena cava,2 cases of external iliac vein and one case of renal vein.The length of laceration was (0.68 ±0.29) cm and blood lost was (114 ++ 79) ml.Results Five of the patients were managed with laparoscopic techniques by suction compressing bleeding sites,dissecting related vessels,adding extra trocar and repairing laceration by suturing in four cases and clipping bleeding site in one case.The bleeding control management lasted (21.0 ± 5.6) min.One laparoscopic adrenalectomty for the treatment of pheochromocytoma converted to open surgery because of increasing blood pressure.All the patients were followed up for (4 ± 2) months.No more related complication occurred.Conclusions Lymph node dissection,local adhesion and energy source are the main causes for blood vascular injuries.This kind of injuries may occur at any stages during a laparoscopic surgery and laparoscopic repairing is safe and feasible.