腹腔镜下筋膜内子宫切除术的临床分析

Clinical analysis of laparoscopic classical intrafascial supracervical hysterectomy

目的对3年来行腹腔镜下筋膜内子宫切除术的104例患者进行总结,探讨其手术的安全性和可行性。方法对104例因子宫肌瘤、子宫肌腺症、功能性子宫出血、子宫内膜异位症等妇科疾病而住院的患者,应用腹腔镜技术明确诊断,同时进行筋膜内子宫切除手术,术后应用病理学检查、B超、阴道镜等技术了解筋膜内子宫切除术后残留宫颈鞘的愈合情况、有无鞘内积血及血肿形成,以及远期病变的发生率,同时对手术方法进行了相应的改进。结果104例腹腔镜下筋膜内子宫切除手术中,均可见鳞-柱交界,无术中大出血及输尿管、肠管等腹腔脏器损伤的并发症。术后5 d常规妇科检查:宫颈残端无活动性出血、无鞘内积血及血肿形成;术后多次阴道镜检查随访,未发现腺体上皮的存在;脱落细胞学检查,无残留宫颈的病变。结论尤其是对盆腔粘连严重的子宫内膜异位症及子宫肌腺症患者,可保留宫颈鞘,避免全子宫切除术引起的各种并发症的发生。腹腔镜下筋膜内子宫切除术是可行的,对于残余宫颈鞘需进行长期的随访。

Objective To summarize the experiences of laparoscopic classical intrafascial supracervical hysterectomy （CISH） in 104 cases within 3 years, and to appraise its safety and feasibility. Methods 104 cases had laparoscopic diagnosis and CISH because of presence of myomas, adenomyosis, functional uterine bleeding or en dometriosis. Pathological examination, B ultrasound, colposcopy were used for follow up to see the cervical stump healing, presence or absence of hematocele or hematoma and the long-term changes. Results In all cases, the squamous-columnar junction were intact with absence of severe bleeding and trauma to ureter or bowel and no cervical stump hematocele. No glandular epithelium or pathological cervical lesions were revealed under vaginoscope. Conclusions CISH is safe in adenomyosis patients with absence of severe pelvic adhesion. （Shanghai Med J, 2005, 2811037-1039）