两种腹腔镜子宫切除术式探析.docVIP

两种腹腔镜子宫切除术式探析 　　【摘要】 目的：探讨腹腔镜子宫切除的临床应用价值。方法：收集我院腹腔镜筋膜内子宫切除术（CISH组）96例和腹腔镜辅助下阴式子宫切除术（LAVH组）45例患者的临床资料，就术式的选择、并发症和中转开腹的原因进行回顾性分析。结果：CISH组手术成功率885%，11例中转开腹者既往有盆腹腔手术史8例，并发症发生率165%，多发生于开展腹腔镜初期。LAVH组手术成功率956%，6例有盆腹腔手术史，均非子宫手术，无1例发生并发症。结论：腹腔镜子宫切除术具有微创、效优的特点，值得临床推广。根据不同的病情选择合适的手术方式是减少并发症，提高手术安全性的关键。 　　【关键词】 子宫切除术；腹腔镜 　　To explore two operative patterns of laparoscopic hysterectomy 　　【Abstract】 Ｏbjective:To explore the clinical value of two kinds of laparoscopic hysterectomy.Methods:Retrospectively analyzed the data of 96 cases by classical intrafasacial superacervical(CISH group)and 45 cases by laparoscopically assisted vaginal hysterectomy (LAVH group),including operative patterns,complications and cause of converting to open operation.Results:The success rate of CISH group is 88.5%, including 8 cases of 11 cases converting to open operation were previously operated in pelvis or abodomen,and the rate of complications is 16.5%.On the contrary,the success rate of LAVH group is 95.6%,including 6 cases were previously operated not in the uterus but in the pelvis or abodomen and there was no any complication.Conclusions:Laparoscopic hysterectomy is worth spreading because of its minimal invasion.Therefore,the key of decreasing complications is based on selecting of proper operative patterns in view of different situation. 　　【Key words】 Hysterectomy;Laparoscopy 　　子宫切除术是妇科最常见的手术之一，而腹腔镜子宫切除术以其损伤小、出血少、恢复快等优点，已成为妇科最受关注的代表性术式，主要有腹腔镜筋膜内子宫切除术（CISH），腹腔镜辅助下阴式子宫切除术(LAVH),腹腔镜全子宫切除术（LTH)，腹腔镜次全子宫切除术（LSH)，目前临床上最常用的是CISH和LAVH。本文收集我院腹腔镜子宫切除术14１例患者的资料，其中CISH 96例，LAVH 45例，就这两种术式的临床应用价值进行回顾性分析，现报道如下。 　　1 资料与方法 　　11 临床资料 我院行腹腔镜子宫切除术14１例，其中CISH 96例，LAVH 45例，35～62岁，平均442岁，既往有盆腹腔手术史CISH组21例，2次以上手术史9例；LAVH组有盆腹腔手术史6例，无2次以上手术史。子宫大小：CISH组＞孕12周27例，孕8～12周54例，＜孕8周15例；LAVH组＞孕12周6例，孕8～12周15例，＜孕8周24例。所有患者均无生育要求，术前常规宫颈细胞学检查及分段诊刮排除恶性病变，术后病理诊断与术前基本一致。 　　12 手术方式 采用气管插管全身麻醉及连续心电监护。 　　121 CISH　参照 Semm 教授改良术，步骤如下：（１）取膀胱截石位，常规消毒铺巾，导尿，头低臀高倾斜30度；（２）切开脐孔上缘刺入气腹针，注入CO2，气压达11～13mm Hg，置入10mm Trocar,放入腹腔镜；（３）在左右下腹相当于麦氏点处分别置入1