腹腔镜复杂子宫全切除术280例临床分析.docVIP

腹腔镜困难子宫全切除术 280 例报告 李平军 李德珍 嵇振岭① 骆亚平② 路永新③ 李霞 鲁德凤 刘长玉 田丽敏 高应丽 孙鸿源② （大连阳光医院微创诊疗中心，大连 116000） 【摘要】 目的 探讨腹腔镜困难子宫全切除术的手术要点和临床价值。 方法 2005 年 3 月～2009 年3 月，对 280 例有子宫全切手术指征的巨大子宫 （子宫≥12 孕周、178 例）、阔韧带肌瘤（14 例）、峡部和宫颈肌瘤（22例）、剖宫产术后（42 例）、盆腔手术史及盆腔严重粘连（24 例）的患者，巨大子宫时采用结扎子宫动脉后处理圆韧带和附件，阔韧带肌瘤、峡部及颈部肌瘤则贴近子宫处理子宫动脉上下分支，子宫与膀胱、直肠粘连时应用膀胱注水、直肠指检协助分辨解剖层次的方法在子宫浆膜下层剥离粘连，施行了腹腔镜子宫全切除术。 结果 280 例全部在腹腔镜下完成子宫全切除术，手术时间（161.2 ± 32.5）min，术中出血量（258.8 ± 96.2）ml，术后肠功能恢复时间（36.9 ± 11.8）h，术后住院时间（6.1 ± 2.4）d。并发症 2 例，直肠阴道瘘 1 例，于 3 个月后在充分准备下施行直肠和阴道修补术治愈，另 1 例为继发腹腔出血，经输血及止血治疗痊愈。随访 223 例，除 8 例术后有少量阴道出血而治愈，其余病例无并发症。 结论 充分术前准备，熟练腹腔镜操作技术，掌握子宫动脉处理技巧，腹腔镜困难子宫全切术是安全可行的。 【关键词】 腹腔镜； 全子宫切除术 Complicated total laparoscopic hysterectomy (report of 280 cases) LI Pingjun，LI Dezhen，Ji Zhenling,et al. Department of Minimally Invasive Surgery, Dalian Yangguang Hospital, dalian 116000, China [abstract] Objective To investigate the operative techniques and clinical value of complicated total laparoscopic hysterectomy. Methods Total laparoscopic hysterectomy were performed in 280 cases diagnosed of Gigantic uteri,pelvic adhesion and previous cesarean section. Results All cases were performed under laparoscopy.The average operative time was（161.2 ± 32.5）min,the average blood loss in operating was（258.8 ± 96.2）ml, the average time of bowel function recovery was（36.9 ± 11.8） h ,the post operative hospital stay ranged（6.1 ± 2.4）d. Postoperative surgery complications occurred in 2 of patients. 1 patient had a rectovaginal fistula and 1 had a abdominal cavity bleeding. All the complications were successfully cured by operation or non-operation method. Conclusion complicated Total hysterectomy can be performed under laparoscopy.It is important for the operator to be familiar with pelvic anatomy and skilled operative techniques must be mastered. [Key words] Laparoscopy; Total hysterectomy; Hard