妇科机器人手术术中并发症防治

doi:10.3877/cma.j.issn.1674-6899.2023.05.007

目的

分析郑州大学第一附属医院妇科微创中心开展机器人妇科手术以来术中并发症发生情况，总结原因及防治措施，以提高手术的安全性。

方法

收集自2014年10月至2022年6月收治于我中心行机器人妇科手术患者的病历资料，对术中并发症进行回顾性分析。

结果

统计机器人手术2000例，发生术中并发症49例，其中血管损伤18例，输尿管损伤18例，膀胱损伤4例，肠管损伤3例，闭孔神经损伤3例，皮下气肿3例。

结论

机器人手术在妇科领域的应用是安全可行的，术中并发症的发生率因术式不同而有所差异。重视并发症，熟悉其发生的相关因素、临床表现、诊断和防治措施对减少和避免并发症的发生至关重要。

关键词: 机器人手术系统, 并发症, 妇科机器人手术

Objective

To analyze the occurrence of intraoperative complications in the Center for Minimally Invasive Gynecologic Surgery at the First Affiliated Hospital of Zhengzhou University, and to summarize the causes and preventive and curative treatment in order to improve the safety of surgery.

Methods

The medical records of patients admitted to our center for robotic gynecologic surgery from Oct. 2014 to Jun. 2022 were collected for retrospective analysis of intraoperative complications.

Results

A total of 2 000 cases of robotic surgery were analyzed, and 49 cases of intraoperative complications occurred, including 18 cases of vascular injuries, 18 cases of ureteral injuries, 4 cases of bladder injuries, 3 cases of intestinal injuries, 3 cases of occlusive nerve injuries, and 3 cases of subcutaneous emphysema.

Conclusion

The application of robotic surgery in gynecology is safe and feasible, and the incidence of intraoperative complications varies depending on the type of surgery. Attention to complications and being familiar with their associated factors, clinical manifestations, diagnosis and prevention is essential to reduce and avoid complications.

Key words: Robotic surgical system, Intraoperative complication, Robotic gynecologic surgery

表1 2000例机器人手术类型和并发症情况[n(%)]

并发症种类	并发症例数(%)	恶性肿瘤1322例(66.1%)				良性疾病678例(33.9%)
并发症种类	并发症例数(%)	宫颈癌	子宫内膜癌	卵巢癌	外阴癌	子宫肌瘤剔除	盆腔脏器脱垂	单纯子宫切除	附件手术
		739(36.95)	412(20.6)	148(12.4)	23(1.15)	134(6.7)	112(5.6)	288(14.4)	144(7.2)
血管损伤	18(0.90)	9(1.21)	4(0.97)	4(2.70)	0	0	0	1(0.35)	0
皮下气肿	3(0.15)	1(0.14)	0	2(1.35)	0	0	0	0	0
肠管损伤	3(0.15)	0	0	2(1.35)	0	0	0	1(0.35)	0
膀胱损伤	4(0.20)	3(0.41)	0	0	0	0	0	1(0.35)	0
输尿管损伤	18(0.90)	14(1.89)	2(0.49)	2(1.35)	0	0	0	0	0
闭孔神经损伤	3(0.15)	0	2(0.49)	1(0.68)	0	0	0	0	0
合计	49(2.45)	27(3.65)	8(1.94)	11(7.43)	0	0	0	3(1.04)	0

表1 2000例机器人手术类型和并发症情况[n(%)]

并发症种类	并发症例数(%)	恶性肿瘤1322例(66.1%)				良性疾病678例(33.9%)
并发症种类	并发症例数(%)	宫颈癌	子宫内膜癌	卵巢癌	外阴癌	子宫肌瘤剔除	盆腔脏器脱垂	单纯子宫切除	附件手术
		739(36.95)	412(20.6)	148(12.4)	23(1.15)	134(6.7)	112(5.6)	288(14.4)	144(7.2)
血管损伤	18(0.90)	9(1.21)	4(0.97)	4(2.70)	0	0	0	1(0.35)	0
皮下气肿	3(0.15)	1(0.14)	0	2(1.35)	0	0	0	0	0
肠管损伤	3(0.15)	0	0	2(1.35)	0	0	0	1(0.35)	0
膀胱损伤	4(0.20)	3(0.41)	0	0	0	0	0	1(0.35)	0
输尿管损伤	18(0.90)	14(1.89)	2(0.49)	2(1.35)	0	0	0	0	0
闭孔神经损伤	3(0.15)	0	2(0.49)	1(0.68)	0	0	0	0	0
合计	49(2.45)	27(3.65)	8(1.94)	11(7.43)	0	0	0	3(1.04)	0

图1 髂外静脉损伤，用血管夹夹闭

图2 缝合后的髂外静脉

图3 子宫操纵杆贯穿肠管

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Prevention and treatment of intraoperative complications in gynecological robotic surgery

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Prevention and treatment of intraoperative complications in gynecological robotic surgery