腹腔镜辅助阴式大子宫切除320例临床分析

Laparoscopic-assisted transvaginal hysterectomy for moderate enlarged uterus: Report of 320 cases

目的探讨腹腔镜辅助阴式大子宫切除术的安全性和可行性。方法对320例子宫增大如12—20孕周、子宫肌腺症患者，行腹腔镜辅助阴式子宫切除术。对手术时间、出血量、副损伤及术后病率进行分析。结果手术过程顺利，无中转开腹。子宫重310，1350g，（580．0±72．3）g。手术时间65—110min，（99．6±35．2）min，出血量100—400ml，（195．6±72．2）ml，术后住院时间4—8d，（5．5±1．2）d。术后病率1．6％（5／320）。297例术后随访2—24个月，平均4．6月，阴道残端愈合良好，无并发症。结论对部分因良性病变≥12孕周子宫，术者具有熟练腹腔镜、阴式手术操作经验，腹腔镜辅助阴式子宫切除术是安全可行的。

Objective To investigate the safety and feasibility of laparoscopic assisted transvaginal hysterectomy （LAVH） for moderate enlarged uterus. Methods Laparoscopic assisted transvaginal hysterectomy was conducted in 320 cases of adenomyosis, with the uterine size equivalent to 12 - 20 gestational weeks. The operation time, blood loss, surgical co-morbidities, and postoperative pyrexia rate were observed and analyzed. Results All the operations were performed smoothly, without conversions to open hysterectomy. The resected myoma weighed 310 - 1 350 g （580.5 ± 72.3 g）. The operating time was 65 - 110 min （99.6 ± 35.2 min）, the blood loss was 100 -400 ml （195.6 ±72.2 ml）, and the postoperative hospital stay, 4 -8 d （5.5 ± 1.2 d）. The postoperative pyrexia rate was 1.6% （5/320）. Follow-up observations in 297 eases for 2 - 24 months （ mean, 4.6 months） showed no complications and good healing of the vaginal wound. Conclusions Laparoscopic assisted transvaginal hysterectomy is safe and feasible for moderate enlarged uterus （≥ 12 gestational weeks） in experienced hands.