腹腔镜下广泛子宫切除加盆腔淋巴结清扫术.DOCVIP

临床医学论文-腹腔镜下广泛子宫切除加盆腔淋巴结清扫术 【摘要】? 目的：评价腹腔镜下广泛子宫切除加盆腔淋巴结清扫术治疗子宫颈癌和子宫内膜癌的实用价值，总结其优点及手术注意事项。方法：对１２例子宫内膜癌、１８例子宫颈癌施行腹腔镜下广泛子宫切除加盆腔淋巴结清扫术。结果：除１例中转开腹外，其余患者均在腹腔镜下完成手术，切除淋巴结19.5个（１３～２４个）。术中重要脏器损伤２例，发生率为６.67%。术后并发症发生率13.33%。子宫内膜癌术后复发率8.33%。子宫颈癌术后复发率5.56%。结论：腹腔镜下广泛子宫切除加盆腔淋巴结清扫术具有创伤小、术野清晰、并发症少、术后康复快等优点，并具有开腹手术的效果。 　　【关键词】? 子宫切除术；盆腔淋巴结切除术；腹腔镜 　　Extensive hysterectomy and pelvic lymphadenectomy under laparoscope:with a report of 30 cases 　　【Abstract】? Ｏbjective:To evaluate the value of extensive hysterectomy and pelvic lymphadenectomy under laparoscope in treating the carcinoma of cervix uteri and endometrium.Methods:12 cases of carcinoma of cervix uteri and 18 cases of carcinoma of endometrium received the extensive hysterectomy and pelvic lymphadenectomy under laparoscope.Results:1 case was converted to?laparotomy,the otheres were finished under laparoscope.2 cases had injury of important viscera,the incidence rate was 6.67%.The incidence of complication,was 13.33%.The recurrence incidence of carcinoma of endometrium was 8.33%.The incidence of recurrence of carcinoma of cervix uteri was 5.56%.Conclusions:The extensive hysterectomy and pelvic lymphadenectomy under laparoscope has merits of minorinvasion,clear visual field,low incidence of post operative complications and quick recovery. 　　【Key words】? Hysterectomy;Pelvic lymphadenectomy;Laparoscopy ??? ２０００年1月至2005年5月我院在腹腔镜下行广泛子宫切除加盆腔淋巴结清扫术30例，取得满意效果，现报道如下。 　　1? 资料与方法 　　11? 临床资料? 　　30例中腹腔镜下行子宫内膜癌根治术12例,４２～７２岁，平均（５０.24±8.76）岁；腹腔镜下行子宫颈癌根治术１８例，３２～６８岁，平均（45.10±12.40）岁。患者均经子宫内膜组织或移子宫颈组织活检确诊。其中子宫内膜癌ⅠＢ期5例，ⅠC期2例，ⅡA期3例，ⅡＢ期2例，其中腺癌10例，腺鳞癌2例，子宫颈癌ⅠA期6例，ⅠB期10例，ⅡA期2例，其中鳞状上皮癌16例，子宫颈管腺癌2例。 　　１2? 手术方法? 　　术前常规阴道冲洗及肠道准备２～３d，术前1d晚及清晨清洁灌肠。已绝经的子宫颈癌患者用7甲基异炔诺酮25mg/d，治疗2～３d。采用气管插管静脉复合麻醉，取膀胱结石位，头低臀高30°。在脐部上方作1cm横切口，建气腹，压力为１２mm Hg，经下腹两侧脐与髂前上髂连线中外１／３交界处，及脐上2横指处置入Trocar，主刀一侧为１０mm Ｔrocar，余为5mm，常规探查腹腔，子宫内膜癌患者抽取腹腔液或腹腔冲洗液查找癌细胞。阴道内常规置举宫器，配合腹腔内操作。将子宫摆向操作侧对方，近盆壁切断圆韧带，剪开阔韧带前、后叶及盆腔后腹膜至近髂总水平，暴露输尿管，用7号丝线或钛夹高位结扎漏斗韧带后切断。用超声刀分离腰大肌外2cm的结缔组织，从髂总动脉分叉处上２～3cm处，打开动脉鞘，提起淋巴组织，