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

Authors：

鱼国盛 , 汤黎明 , 朱剑飞 , 钱峻

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Keywords：

腹腔镜手术; 穿刺孔出血; 原因; 对策

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目的探讨腹腔镜手术中穿刺相关出血的常见原因及相应的对策。方法对2000年5月至2010年10月期间我院腹腔镜手术中发生与穿刺相关出血的16例患者的资料进行回顾性分析。结果16例患者中腹壁穿刺孔腹膜层出血7例，肌层出血5例，误伤大网膜血管3例，误伤后腹膜血管1例，均在术中及时发现。误伤大网膜血管病例予镜下止血，误伤后腹膜血管病例及时中转开腹手术，腹膜层及肌层出血病例分别给予电灼或缝扎止血。患者均康复出院。结论直视进腹、规范操作和抽吸滴水试验是避免腹腔镜手术穿刺时血管误伤及出血遗漏的有效方法。

Citation： 鱼国盛,汤黎明,朱剑飞,钱峻. 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.	郑民华，马君俊. 腹腔镜外科在争议中发展 [J]. 中国普外基础与临床杂志， 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.	赵学英，冷金花，郎景和，等．妇科腹腔镜手术中血管损伤的临床分析 [J]．中国微创外科杂志， 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. 郑民华，马君俊. 腹腔镜外科在争议中发展 [J]. 中国普外基础与临床杂志， 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. 赵学英，冷金花，郎景和，等．妇科腹腔镜手术中血管损伤的临床分析 [J]．中国微创外科杂志， 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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