The Investigation and Analysis of Laparoscopic Puncture-Related Hemorrhage_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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魚國盛 , 湯黎明 , 朱劍飛 , 錢峻

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Keywords：

腹腔鏡手術; 穿刺孔出血; 原因; 對策

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目的探討腹腔鏡手術中穿刺相關出血的常見原因及相應的對策。方法對2000年5月至2010年10月期間我院腹腔鏡手術中發生與穿刺相關出血的16例患者的資料進行回顧性分析。結果16例患者中腹壁穿刺孔腹膜層出血7例，肌層出血5例，誤傷大網膜血管3例，誤傷后腹膜血管1例，均在術中及時發現。誤傷大網膜血管病例予鏡下止血，誤傷后腹膜血管病例及時中轉開腹手術，腹膜層及肌層出血病例分別給予電灼或縫扎止血。患者均康復出院。結論直視進腹、規范操作和抽吸滴水試驗是避免腹腔鏡手術穿刺時血管誤傷及出血遺漏的有效方法。

Citation： 魚國盛,湯黎明,朱劍飛,錢峻. The Investigation and Analysis of Laparoscopic Puncture-Related Hemorrhage. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(11): 1214-1215. doi: Copy

1.	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.
2.	鄭民華，馬君俊. 腹腔鏡外科在爭議中發展 [J]. 中國普外基礎與臨床雜志， 2007， 14（5）： 503505.
3.	Santala M, Jrvel L, Kauppila A. Transfundal insertion of a Veress needle in laparoscopy of obese subjects: a practical alternative [J]. Hum Reprod, 1999, 14(9): 22772278.
4.	Chapron C, Dubuisson JB, Querleu D, et al. Complications of laparoscopy: a prospective multicentre observational study [J]. Br J Obstet Gynaecol, 1997, 104(12): 14191420.
5.	Mayol J, GarciaAguilar J, OrtizOshiro E, et al. Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion [J]. World J Surg, 1997, 21(5): 529533.
6.	Guloglu R, Dilege S, Aksoy M, et al. Major retroperitoneal vascular injuries during laparoscopic cholecystectomy and appendectomy [J]. J Laparoendosc Adv Surg Tech A, 2004, 14(2): 7376.
7.	van der Voort M, Heijnsdijk EA, Gouma DJ. Bowel injury as a complication of laparoscopy [J]. Br J Surg, 2004, 91(10): 12531258.
8.	趙學英，冷金花，郎景和，等．婦科腹腔鏡手術中血管損傷的臨床分析 [J]．中國微創外科雜志， 2005， 5（3）： 178180．.
9.	Orlando R, Lirussi F. Delayed recognition of inadvertent gut injury during laparoscopy [J]. Surg Endosc, 2000, 14(12): 1188.
10.	Leron E, Piura B, Ohana E, et al. Delayed recognition of major vascular injury during laparoscopy [J]. Eur J Obstet Gynecol Reprod Biol, 1998, 79(1): 9193.
11.	Brown JA, Canal D, Sundaram CP. Opticalaccess visual obturator trocar entry into desufflated abdomen during laparoscopy: assessment after 96 cases [J]. J Endourol, 2005, 19(7): 853855.
12.	Long JB, Giles DL, Cornella JL, et al. Open laparoscopic access technique: review of 2 010 patients [J]. JSLS, 2008, 12(4): 372375.
13.	Liu HF, Chen X, Liu Y. A multicenter study of a modified open trocar firstpuncture approach in 17 350 patients for laparoscopic entry [J]. Chin Med J (Engl), 2009, 122(22): 27332736.
14.	Agresta F, De Simone P, Ciardo LF, et al. Direct trocar insertion vs. Veress needle in nonobese patients undergoing laparoscopic procedures: a randomized prospective singlecenter study [J]. Surg Endosc, 2004, 18(12): 17781781.
15.	McGinnis DE, Strup SE, Gomella LG. Management of hemorrhage during laparoscopy [J]. J Endourol, 2000, 14(10): 915920.

1. 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.
2. 鄭民華，馬君俊. 腹腔鏡外科在爭議中發展 [J]. 中國普外基礎與臨床雜志， 2007， 14（5）： 503505.
3. Santala M, Jrvel L, Kauppila A. Transfundal insertion of a Veress needle in laparoscopy of obese subjects: a practical alternative [J]. Hum Reprod, 1999, 14(9): 22772278.
4. Chapron C, Dubuisson JB, Querleu D, et al. Complications of laparoscopy: a prospective multicentre observational study [J]. Br J Obstet Gynaecol, 1997, 104(12): 14191420.
5. Mayol J, GarciaAguilar J, OrtizOshiro E, et al. Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion [J]. World J Surg, 1997, 21(5): 529533.
6. Guloglu R, Dilege S, Aksoy M, et al. Major retroperitoneal vascular injuries during laparoscopic cholecystectomy and appendectomy [J]. J Laparoendosc Adv Surg Tech A, 2004, 14(2): 7376.
7. van der Voort M, Heijnsdijk EA, Gouma DJ. Bowel injury as a complication of laparoscopy [J]. Br J Surg, 2004, 91(10): 12531258.
8. 趙學英，冷金花，郎景和，等．婦科腹腔鏡手術中血管損傷的臨床分析 [J]．中國微創外科雜志， 2005， 5（3）： 178180．.
9. Orlando R, Lirussi F. Delayed recognition of inadvertent gut injury during laparoscopy [J]. Surg Endosc, 2000, 14(12): 1188.
10. Leron E, Piura B, Ohana E, et al. Delayed recognition of major vascular injury during laparoscopy [J]. Eur J Obstet Gynecol Reprod Biol, 1998, 79(1): 9193.
11. Brown JA, Canal D, Sundaram CP. Opticalaccess visual obturator trocar entry into desufflated abdomen during laparoscopy: assessment after 96 cases [J]. J Endourol, 2005, 19(7): 853855.
12. Long JB, Giles DL, Cornella JL, et al. Open laparoscopic access technique: review of 2 010 patients [J]. JSLS, 2008, 12(4): 372375.
13. Liu HF, Chen X, Liu Y. A multicenter study of a modified open trocar firstpuncture approach in 17 350 patients for laparoscopic entry [J]. Chin Med J (Engl), 2009, 122(22): 27332736.
14. Agresta F, De Simone P, Ciardo LF, et al. Direct trocar insertion vs. Veress needle in nonobese patients undergoing laparoscopic procedures: a randomized prospective singlecenter study [J]. Surg Endosc, 2004, 18(12): 17781781.
15. McGinnis DE, Strup SE, Gomella LG. Management of hemorrhage during laparoscopy [J]. J Endourol, 2000, 14(10): 915920.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The Investigation and Analysis of Laparoscopic Puncture-Related Hemorrhage

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