新式筋膜内子宫切除术200例临床研究.docVIP

新式筋膜内子宫切除术200例临床研究[摘要] 目的 探讨新式筋膜内子宫切除术的临床价值。方法 子宫及附件的良性病变需要切除子宫者200例,行新式筋膜内子宫切除术作为观察组,对照组100例行传统式子宫切除术,比较两组手术时间、术中出血量、术中术后并发症等。结果 观察组手术时间为(50±10.5)min,对照组(110±38.6)min(P0.05);观察组术中术后并发症均低于对照组。结论 该术式临床效果良好,值得推广。 [关键词] 改良;筋膜内;子宫切除;效果 [中图分类号] R713.42[文献标识码] A [文章编号] 1673-9701(2009)34-147-02 Improved Intrafascial Hysterectomy: A Clinical Analysis of 200 Cases WEI Cuiping Obstetrics and Gynecology,Shen County Chinese Medicine Hospital,Shandong Province,Shen County 252400,China [Abstract] Objective To explore the clinical value of improved intrafascial hysterectomy. Methods We selected 200 cases,which needed hysterectomy due to benign uterine lesions of the uterus and its accessories,to undergo improved intrafascial hysterectomy as treatment group and selected 100 cases to undergo traditional hysterectomy as control group. We compared operative time,blood loss,surgery and postoperative complications between the two groups. Results The operative time of the treatment group was(50±10.5)min and that of the control group was (110±38.6)min, with a significant difference between the two groups(P0.05). The postoperative complications were fewer in the treatment group than those in the control group. Conclusion The improved intrafascial hysterectomy has good clinical effects,worthy of popularization. [Key words] Improvement;Intrafascial;Hysterectomy;Efficacy 随着微创手术在妇科临床的不断开展,探讨创伤小、恢复快、安全性高的术式,已成为妇产科临床医师的共识。我科自2002年1月~2006年1月采用改良的新式筋膜内子宫切除术,效果良好。 1 资料与方法 1.1 一般资料 自2002年1月~2006年1月,在本科住院的子宫及附件良性病变需切除子宫患者300例,其中功血40例,子宫肌瘤118例,子宫肌腺病49例,卵巢良性肿瘤70例,其他23例。年龄45~60岁。随机分为观察组200例,对照组100例,两组在手术指征、年龄、疾病种类等方面无差异性。 1.2 方法 观察组采用下腹横切口,皮下脂肪及筋膜层均横行钝性撕拉,锐性分离肌腱与筋膜粘着处,撕拉开腹直肌,剪断与耻骨连接的部分肌腱,横行剪开腹膜,提拉子宫,将卵巢固有韧带、输卵管峡部及圆韧带一次钳夹切断、缝扎。若需切除附件则分次钳夹切断圆韧带及骨盆漏斗韧带。剪开并分离膀胱反折腹膜,稍下推膀胱,与子宫峡部水平钳夹切断子宫动静脉上行支,在子宫动脉断端上方0.5cm处环行切开宫颈筋膜深约0.3~0.5cm,边向上提拉子宫边向下锐性分离宫颈筋膜达宫颈阴道部切除子宫,缝合宫颈筋膜及阴道残端,关闭盆底腹膜,常规关腹[1]。皮肤用3/0可吸收线行皮内缝合,术后无须拆线。对照组采用腹式纵切口传统术式切除子宫,术后7~8d拆线。两组均采用连续硬膜外麻醉。 1.3 统计学处理 采用t检验及χ2检