阻断子宫动脉的腹腔镜筋膜内子宫切除术60例报告

Classic intrafascial supracervical hysterectomy by including the clipping of the uterine artery: Report of 60 cases

目的探讨阻断子宫动脉的腹腔镜筋膜内子宫切除术（classic intrafascial supracervical hysterectomy。CISH）的临床应用价值。方法子宫良性疾病60例在腹腔镜下分离出子宫动脉后钛夹夹闭，阻断子宫动脉后行筋膜内子宫切除术。结果手术均获成功，无中转开腹，无手术并发症。手术时间72～186min，（91．4±26．3）min；术中出血量50-150ml，（76．5±20．6）ml；术后肠功能恢复时间18～30h；（22．7±5．8）h；24h引流液50—160ml，（80．5±31．8）ml。术后2例体温38．5℃，术后病率3．3％（2／60）。术后住院4～7d。60例随访6～18个月，（10．6±4．2）月，3例在1～3个月阴道点滴出血。经抗感染、止血等治疗5～7d治愈。结论阻断子宫动脉的腹腔镜筋膜内子宫切除术是CISH的技术改进，并发症少，安全，效果好，值得临床推广。

Objective To investigate the clinical value of classic intrafascial supracervical hysterectomy （CISH） by including the clipping of the uterine artery. Methods A total of 60 cases of benign uterine diseases were included in the study. After the uterine artery had been dissected and clipped on both sides under laparoscope, classic intrafascial supracervical hysterectomy was performed. Results All the operations were performed successfully under laparoscope. No conversions to open surgery were needed. Operating complications happened in no case. The operating time was 72 - 186 min （91.4 ± 26.3 min） , the amount of blood loss was 50 ± 150 ml （76.5 ± 20.6 ml）, the time to postoperative gastrointestinal function recovery was 18 ± 30 h （22.7 ± 5.8 h）, and the volume of pelvic drainage within 24 hours, 50 ± 160 ml （ 80.5 ± 31.8） ml. Postoperative body temperature was elevated to 38.5 ℃ in 2 cases, the postoperative pyrexia rate being 3.3%. The length of postoperative hospital stay was 4 ± 7 d. Follow-up for 6 - 18 months （ 10.6±4.2 months） in the 60 cases showed 3 cases of small amount of vaginal bleeding at 1 - 3 months, which were cured with the use of antibiotics and hemostatics for 5 - 7 d. Conclusions Classic intrafascial supracervical hysterectomy by including the clipping of the uterine artery is a safe and effective improvement to CISH technique.