腹腔镜下大子宫全切78例手术体会

Laparoscopic hysterectomy for large uterus by using bipolar a report of 78cases

目的探讨使用双极电凝行腹腔镜下巨大子宫切除术的安全性及手术技巧。方法回顾性分析2006年1月～2007年12月78例子宫超过12孕周行腹腔镜下全子宫切除术的临床资料。手术中置镜位置采取在宫底上至少3～4cm。手术关键步骤是处理附件及游离好子宫血管。结果78例全部在腹腔镜下完成手术，无一例中转开腹。2例术后出现阴道残端炎，余无严重并发症发生。手术时间112min（88～136min），术中出血158ml（60—266ml）术后住院时间（5．1±0．9）d。78例随访6个月，无一例出现术后并发症。结论选择合适的置镜孔，处理好附件及子宫血管，使用双极电凝行腹腔镜下巨大子宫切除术经济、安全、可行，不会增加手术危险性和手术并发症，但对术者要求具备丰富的镜下手术经验。

Objective To investigate the operative safety and skills of laparoscopic hysterectomy of large uterus by using bipolar. Methods use retrospective method to analysis the clinical data of 78 cases whose uterus were bigger than twelve gestational age uterus and treated with total laparoscopic hysterectomy from January 2006 to December 2007. The location of laparoscopy was determined to be at least 3-4cm above the fundus of uterus. The most crucial step was the treatmen to fadnexa and uterine blood vessels.Results All operations （78 cases） were performed successfully under laparoscopy and no severe operative complications were noticed except for 2 cases of remnent vagina inflammation The average operation time and the intraoperative blood loss were 112 min （88-136min） and 158mi （60-266ml） respectively. The average postoperative hospital stay was（5.1 ±0.9）days. No severe postoperative complication was found in all cases during the 6-month follow-up. Conclusion Total Laparoscopic hysterectomy of large uterus is safe and feasible by using bipoar, and does not increase operative risk and incidence of complications when suitable laparoscopic location is selected and treatments of adnexa and uterine vessel are well performed, but the most important is the operator must have rich laparoscopic operative experence.