腹腔镜辅助下阴式子宫切除治疗严重子宫内膜异位症17例临床分析

Clinical Analysis of Laparoscopically Assisted Vaginal Hysterectomy in Patients with Uterine Myoma or Severe Endometriosis

目的:探讨腹腔镜辅助下阴式子宫切除治疗严重子宫内膜异位症患者的疗效及手术技巧。方法:选择同期由同一手术组进行的腹腔镜辅助下阴式子宫切除术病例,其中子宫肌瘤患者26例,子宫内膜异位症Ⅲ期及以上17例,比较两组的手术时间、术中出血量、手术并发症、肛门排气时间、术后病率及术后住院天数。结果:子宫肌瘤组手术时间77±19分钟,严重子宫内膜异位症组为131±34分钟,两组比较P<0.05,差异有显著性;子宫肌瘤组术中出血量为105±35ml,严重子宫内膜异位症组为125±35 ml,两组比较P>0.05,差异无显著性。两组均无手术并发症。结论:采用腹腔镜辅助下经阴道内手指分离子宫直肠陷凹的粘连,直肠内手指辅助指引,提高了严重子宫内膜异位症患者腹腔镜下经阴道子宫切除手术的安全性及成功率,扩大了腹腔镜的手术指征。

Objective. To approach the operative technique in laparoscopically assisted vaginal hysterectomy （LAVH） in patient with severe endometriosis. Methods：Seventeen of endometriosis stage Ⅲ or IV were assigned to laparoscopically assisted vaginal hysterectomy, meantime, twenty-six women of myoma whose tumor size over 8 gestation weeks underwent LAVH by the same doctor as controls. The operative time, blood volume, operative complication, passage of gas by anus, postoperative morbidity and hospital days after operation were analysis and compared between two groups.Results：Mean operative time was shorter in myoma group （77± 19min） than endornetriosis group （131 ± 34min） （ P〈0.05）, The blood loss in myorna group and endometriosis group were 105~ 35ml and 125 ± 35ml, respectively （ P 〉 0.05）. There was no operative complication in two groups. Conclusions： It was useful to transvaginally split adherence of Douglas fosse by fingers and instructed by finger inside rectum with laparoscopic assist, which also improve safety and success of LAVH in severe endometriosis.