免气腹腔镜子宫全切术后阴道残端悬吊在临床意义.docVIP

免气腹腔镜子宫全切术后阴道残端悬吊在临床的意义 　　【中图分类号】R734.6 【文献标识码】A 【文章编号】2095-6851（2016）11-0-01 【Abstract】Objective To investigate the superiority of using the vaginal stump suspension after gasless laparoscopic hysterectomy to prevent the vaginal stump prolapse after surgery. Methods from September 2014 to September 2015，168 patients who needed gasless laparoscopic hysterectomy in our hospital were divided into two groups， 88 patients from Group A had been operated on using vaginal stump suspension after gasless laparoscopic hysterectomy， and 80 patients from Group B had been operated on using vaginal stump suspension without gasless laparoscopic hysterectomy. Results The two groups in operation time， blood loss， hospital stay after operation， postoperative anal exhaust time， active time post-operation， postoperative pain have no significant difference （P0.05）. And there are significant differences between the two groups at the postoperative vaginal length changes，including the time after operation， three months after operation and six months after operation，and sexual life satisfaction score （P0.05）.术前患者常规行阴道镜检查及宫颈细胞学检查，查癌胚抗原，所有患者排除严重的心肺肝肾病变及妇科恶性肿瘤， 1.2手术方法： 1.2.1麻醉与体位 均采用腰麻+连续硬膜外麻醉+静脉复合麻，所有患者头低臀高（约15-20度）臀部超出手术台5-10cm左右 1.2.2手术器械采用奥林巴斯电视腹腔镜系统及国产的手术器械还有少量的开腹器械，术前准备：常规阴道准备及肠道准备，①麻醉成功后患者取膀胱截石位，头臀在同一水平位，阴道消毒后探针测量处女膜至后穹隆顶端的长度后取头低臀高（约15-20度）臀部超出手术台5-10cm左右。放置举宫杯操纵子宫，采用皮下悬吊法，常规下腹4孔法，于脐孔处约做约1.2cm的横行纵形小切口，用两把巾钳钳夹切口两侧皮肤向上提起腹壁，再用10mmTrocar穿刺进入腹腔，用骨科kirschner wire针在脐旁开5cm-6cm下约3-4cm顺腹白线方向向下自耻骨联合上约5-6cm左右穿出（长约8-10cm），kirschner wire针两端固定后用吊链挂于悬吊棒横杆，充分暴露腹腔手术空间，镜下探查所取的穿刺部位有无大网膜及肠管粘连，右侧穿刺孔取右侧麦氏点处3cm，左侧分别于麦氏点对应点外约2cm及脐旁开约8-9cm，作两个5cm穿刺孔，两孔距离约7-8cm，将Trocar的密封帽取掉进行操作。打开下推膀胱腹膜反折，距离子宫角2-4cm切断子宫圆韧带、卵巢固有韧带、子宫血管、宫旁组织及骶韧带，环形切开阴道壁将子宫切除，1-0微乔线从右到左连续缝合阴道残端，缝合至阴道左侧打结后将左侧圆韧带，骶韧带及阴道左残端缝合在一起，再从左到右连续缝合加固阴道残端，缝至右阴道残端后再次打结后将右侧圆韧带、骶韧带及阴道阴道残端缝合在一起，将阴道残端上提。术后将患者放至头臀在同一水平位。再次测量处女膜至阴道顶端长度。 　　对照组B组 同法将子宫切除后，1-0微乔线从右到左连续缝合阴道残端，缝合至阴道左侧打结，再从左到右连续缝合加固阴道残端，缝至右侧打结。手术后将患者放至头臀在同一水平位。再次测量处女膜至阴道顶端长度 1.2.3阴道长度疗效评定：显效：