目的探讨腹腔镜下子宫全切/次全切除手术并发症的原因和防治措施。方法对2004年1月~2010年10月2475例腹腔镜下子宫全切/次全切除手术的临床资料进行回顾性分析。结果发生并发症279例(11.3%),其中出血10例、肠道热灼伤4例、膀胱损伤1例、输尿管损伤1例、皮下气肿118例、感染10例、神经损伤7例、术后肩痛114例、暴露性角膜炎5例、皮肤电损伤5例、输卵管自阴道切缘脱出1例、切口疝3例。并发症中开腹处理1例,再次腹腔镜手术7例。2004~2006年并发症234例,手术并发症发生率31.4%(234/746),2007~2010年并发症45例,手术并发症发生率2.6%(45/1729)。279例并发症中,以皮下气肿和术后肩痛多见,其中204例发生在前三年,28例发生在后四年,发生率分别为27.3%(204/746)、1.6%(28/1729)。结论手术操作技术不成熟、腹腔镜开展初期、术中视野暴露不佳、穿刺口过大、未辨清解剖结构盲目操作、盆腹腔严重粘连、切口异物污染、腹腔内气体残留、穿刺口未避开腹壁血管是发生并发症的关键。 Objective To investigate the causes and prevention measures of laparoscopic total / subtotal hysterectomy. Methods From January 2004 to October 2010 2475 cases of laparoscopic hysterectomy / subtotal resection clinical data were retrospectively analyzed. Results The complications occurred in 279 cases (11.3%), including 10 cases of bleeding, 4 cases of intestinal thermal burns, 1 case of bladder injury, 1 case of ureteral injury, 118 cases of subcutaneous emphysema, 10 cases of infection and 7 cases of nerve injury. Shoulder pain in 114 cases, 5 cases of keratitis exposure, skin electrical injury in 5 cases, fallopian tube from the vaginal margin prolapse in 1 case, 3 cases of incisional hernia. Complications of laparotomy in 1 case, again laparoscopic surgery in 7 cases. There were 234 cases of complications in 2004-2006, with a complication rate of 31.4% (234/746), 45 cases of complications in 2007-2010, and a complication rate of 2.6% (45/1729). Of the 279 complications, subcutaneous emphysema and postoperative shoulder pain were more common, of which 204 occurred in the first three years and 28 occurred in the last four years, with rates of 27.3% (204/746) and 1.6% (respectively) 28/1729). Conclusions The technique of operation is immature, laparoscopic initial stage, poor intraoperative visual field exposure, excessive puncture, blind operation of anatomical structure, serious abdominal adhesions, incisional foreign body contamination, intra-abdominal gas residue, puncture unavoidable Open abdominal wall vessels is the key to complications.