腹腔镜卵巢囊肿剥除术32例临床分析.DOCVIP

临床医学论文-腹腔镜卵巢囊肿剥除术32例临床分析 【摘要】? 目的：探讨腹腔镜卵巢囊肿剥除术的术前筛查、手术要点、及临床应用价值。方法：回顾分析了从2003年6月至2005年10月行腹腔镜卵巢囊肿剥除术32例的临床资料。结果：32例卵巢囊肿均成功在腹腔镜下完成了手术,术中出血平均80ml,手术平均时间55min,平均住院天数５d,无1例中转开腹。术后无腹膜炎发生,2例发生皮下气肿,24h自然恢复,2例粘液性囊腺瘤术中破裂,已随诊一年,无腹膜假粘液瘤发生。结论：如果病例选择恰当,在腹腔镜下行卵巢囊肿剥除术安全,微创,康复快,疗效肯定,值得临床推广应用。 　　【关键词】? 卵巢囊肿剥除术；腹腔镜 　　Clinical analysis of 32 cases with laparoscopic oophorocystectomy 　　【Abstract】? Ｏbjective:To explore the preoperative screening,operative technique and clinical applications of laparoscopic oophorocystectomy.Ｍethods:From June 2003 to October 2005,32 cases with laparoscopic oophorocystectomy were analyzed retrospectively.Ｒesults:All operations were successful.The average blood loss during operation was 80ml,the mean operation time was 55min,the mean hospitalization was 5 days.No one was converted to laparotomy.No chemical peritonitis occurred,2 cases of subcutaneous emphysema were restored after 24 hours,2 cases of mucinous cyseadenoma of ovary broken during operation were followed up for one year and no patient developed pseudomyxoma peritonei after surgery.Ｃonclusions:The laparoscopic oophorocystectomy is a preferable method which has advantages of safety,minimal invasion and quick recovery,It might be popularized to clinical practice. 　　【Ｋey words】? Oophorocystectomy;Laparoscopy 　　随着微创技术的广泛开展,卵巢囊肿剥除术已是腹腔镜成熟的手术之一［１］,现将2003年6月至2005年10月在我院用腹腔镜手术剥除卵巢囊肿32例的治疗结果报道如下。 　　１? 资料与方法 　　１１? 临床资料? 32例患者24~37岁,平均295岁,21例在体检时发现,6例因下腹痛、5例因月经紊乱就诊时发现,所有病例术前经妇科检查,B超和CA125检查排除恶性肿瘤可能,疾病种类有:卵巢子宫内膜异位囊肿13例,卵巢单纯性囊肿9例,卵巢畸胎瘤7例,卵巢粘液性囊腺瘤3例,28例卵巢囊肿为单侧,4例为双侧,2例有盆腔手术史。 　　１２? 手术方法? 全部病例均采用气管插管加静脉全身麻醉,患者取头低臀高膀胱截石位,建立气腹,腹压达12~14mm Hg,在脐部穿刺10mm Trocar,置入25°广角腹腔镜,在左、右下腹(相当于麦氏点水平)插入5~10mm Trocar 2个,举宫,探查盆、腹腔,了解囊肿大小,活动度,表面有无赘生物,初步确定为良性囊肿,方可进行手术。若盆腔粘连严重,在耻上3cm左侧脐韧带外侧插入5mm Trocar,以便于操作。钝性或锐性分离盆腔粘连,用无损伤钳撬起卵巢囊肿,置于子宫前上方,用单极电凝钩在卵巢囊肿的游离侧切开卵巢皮质2cm深达囊壁,在卵巢囊壁与正常卵巢组织的分界面用吸引器头钝性分离,囊壁与卵巢皮质粘连紧密者用单极电凝钩切开,活动出血处双极电凝止血以防影响手术进行,逐步尽量将囊肿完整剥除;若囊壁薄手术过程中破裂,则吸净囊液并反复冲洗后再剥除囊壁,囊肿基底处血管先用双极电凝凝固后,锐性切除囊肿,创面用双极电凝止血,用标本袋将肿物取出,囊肿内壁有乳头状结节者需