Clinical Analysis Of The Complications Of Gynecological Laparoscopic Surgery

ObjectiveTo investigate the causes,diagnosis,treatment and prevention of the complications of gynecological laparoscopic surgery.Materials and MethodsA retrospective analysis was done on clinical data of gynecological laparoscopic surgery in Shandong Provincial Qianfoshan Hospital from January 1,2013 to December 31,2017.ResultsA total of 4749 cases underwent gynecological laparoscopic surgery in Shandong Provincial Qianfoshan Hospital from January 1,2013 to December 31,2017,in which 20 cases with complications happened,the total incidence of complications of laparoscopic surgery was 0.42%.The incidence of laparoscopic complications in 2014 was much lower than in 2013 and the rate in 2015 was similar to that in 2014.The highest incidence rate was in 2016 while the rate was reduced in 2017.According to surgical classification,from 2013 to 2015 laparoscopic surgical complications happened in the third-level surgery and the fourth-level surgery and it occurred mainly in the third-level surgery and the fourth-level,in addition to the second-level surgery in 2016,while complications occurred in the fourth-level surgery in 2017;four laparoscopic surgical groups,surgical complications are statistically significant differences in comparison.Surgical type: From 2013 to 2015 laparoscopic surgical complications happened in hysterectomy and malignant tumor surgery;in 2016 complications occurred mainly in the adnexal operations,in addition to hysterectomy and malignant tumor surgery;in 2017 complications occurred in malignant tumor surgery;four laparoscopic surgical groups,surgical complications are statistically significant differences in comparison.Complications: Ureteral injury in 3 cases were identified intraoperatively,including 1 case with ureteral heat injury and 2 cases with ureteral epicardial injury,in which 1 case appeared ureterostoma.Three cases underwent placement of ureteral double-J tube.The other 2 cases of ureteral injury were found postoperatively and received uerterovesicostomy.Intestinal injury in 5 cases were identified intraoperatively,including 3 cases of sigmoid colon injury,1 case of rectum injury and 1 case of transverse colon injury.Four cases were repaired laparoscopically.One case received transverse colostomy.One abdominal hematoma were underwent hematoma removal.Two cases of vascular injury were repaired during operation.There were 3 cases of postoperative bleeding,2 cases underwent laparoscopic hemostasis and 1 case received hemostasis by laparotomy.Obturator nerve injury in 2 cases were identified and repaired intraoperatively.One case of vaginal stump healing underwent vaginal suture.Pelvic abscess in 1 case were treated by conservative treatment.Conclusion1.From January 2013 to December 2017,the incidence of gynecological laparoscopic surgery complications in Qianfoshan Hospital was 0.42%,which is similar with that reported in literature.2.Indications for laparoscopic surgery are expanding with the maturity of laparoscopic technology.In the past five years,the proportion of malignant tumor radical surgery has been increasing.3.The type of disease,abdominal environment,surgical type,Physician experience and the general condition of the patient are related to the occurrence of complications.4.Early diagnosis is of vital importance for its prognosis.5.The keypoint to reducing the complications of laparoscopic surgery is to master the indications of laparoscopic surgery strictly,to strengthen the classification system of surgical management,to understand anatomy knowledge,to improve surgical technique,to learn the rational usage of electrosurgical instruments and timely conversion to laparotomy.