腹腔镜子宫切除术中宫旁缝合套扎的应用.DOCVIP

临床医学论文-腹腔镜子宫切除术中宫旁缝合套扎的应用 ?????????? 作者：林长华 邵珊珊 谢桂芹 【摘要】目的：分析、讨论腹腔镜下全子宫切除术中子宫动静脉的处理方法。方法：回顾性分析23例腹腔镜下全子宫切除术中子宫静脉的处理方法、分析宫旁缝扎组与血管游离后处理组及腹腔镜联合阴式子宫切除组的手术时间、术中出血量及术后发病率。结果：宫膀缝扎组与血管游离后处理组病人的手术时间、术后出血量及术后发病率比较差差异没有显著性，宫膀缝扎后再电凝切断子宫血管及主韧带，在腹腔镜子宫切除术中具有出血少、简单易行的优点。 ??? 【关键词】腹腔镜；全子宫切除 ??? Study of treatment of uteri blood vessel on 25 patients with laparoscopic hysterecyomy ???? 【Abstract】Ｏbjective:To study the treatment method of uteri activity and inhtertia with laparoscopc panhysterectomy.Methods:The treatment method of uteri activity and intertia on 23 patients with laparoscopic panhysterectomy was analyzed retrospectively. The operation time,?the volume of blood and rate of sickness afier operation among the group of transfixion on the parauteri, the group of freeing vessel and the group of associating perineum by laparoscope were compared. Results:The operation time, the volume of blood and rate of sickness after operation were not significant difference between the group of?transfixion on the para-uteri and the group of fieeing blood vessel. The operation time and rate of sickness after operation were not significant difference between the group of tiansfixion on the parauteri and the group of associating perineum by laparoscope, but the volume of blood decreased strikingly.Conclusions:Breaking uteri blood vessel and cardinal ligament by electric coagulation after transfixion on the para-uteri are easy to operare, demand some simple instruments, and have a good operative field. It has an important clinical application value on laparoscopic hysterectomy. ??? 【Key words】Laparoscope; Panhysterectomy ??? 1资料与方法 ??? 11临床资料2００3年6月至2003年11月，我院对25例病人行腹腔镜下全子宫切除术，其中采用宫旁缝扎有14例。本组年龄26～56岁，平均435岁。宫颈癌（Ｉal）2例，宫颈原位癌3例，子宫内膜腺癌（Ia）3例，子宫肌瘤2例，子宫腺肌瘤1例，其他3例。采用游离子血管后再结扎或钛夹后切断的病人有11例，此组为同期内入住另一病区病人（随机入院），年龄36～57岁，平均46岁。宫颈原位癌2例，ＣIN Ⅲ级2例，子宫内膜癌（Ｉa）１例，子宫内膜复杂增生2例，子宫肌瘤合并子宫脱垂２例。同期内进行了腹腔镜联合阴式子宫切除术35例，子宫动静脉均经阴道处理，年龄44～６０岁，平均52岁。子宫肌瘤27例，子宫腺肌瘤3例，多发性子宫内膜息肉1例，左卵巢纤维卵泡细胞瘤1例，右卵巢透明细胞癌（Ia），功能性子宫出血1例，子宫脱垂伴阴道壁