妇科无气腹腹腔镜下手术58例报告

Gasless Laparoscopic Surgery for Gynecological Diseases:Report of 58 Cases

目的探讨无气腹腹腔镜手术在妇科手术中应用的临床价值。方法2006年10月～2007年12月,应用日本岛科公司生产的无气腹腹腔镜手术的悬吊腹壁器械施行无气腹腹腔镜下手术58例,其中卵巢囊肿剔除术31例,子宫肌瘤剔除术23例,腹腔镜辅助阴式子宫切除术(LAVH)3例,输卵管妊娠输卵管切除术1例。两孔27例(其中卵巢囊肿剔除术11例,子宫肌瘤剔除16例),三孔18例(其中囊肿剔除术9例,子宫肌瘤剔除术5例,LAVH3例,输卵管切除术1例),一孔13例(其中卵巢囊肿剔除术11例,子宫肌瘤剔除术2例,应用宫腔镜电切镜作为目镜指引手术)。结果58例手术均获成功。卵巢囊肿剔除术中失血量(46·8±10·1)ml,手术时间(66·3±6·7)min;子宫肌瘤剔除术中失血量(94·3±8·2)ml,手术时间(104·3±6·7)min;3例LAVH术中失血量分别为100、200、150ml,手术时间255、240、135min;1例输卵管切除手术时间30min。58例中无手术并发症,术后住院(7·9±1·6)d。术后随访3～6个月,均无并发症发生。结论无气腹腹腔镜手术是一种安全有效的妇科微创手术方法,拓宽妇科腹腔镜手术适应证;其手术操作有一定灵活性,更适合老年人和合并心血管病的不能全麻的患者。

Objective To discuss the safety and efficacy of gasless laparoscopy in gynecological surgery. Methods A total of 58 patients who received gasless laparoscopic surgery from October 2006 to December 2007 were enrolled in this study. Among the patients, 31 underwent ovarian cystectomy, 23 received myomectomy, 3 laparoscopic-assisted transvaginal hysterectomy （LAVH）, and 1 salpingectomy （ because of ectopic pregnancy）. One trocar was used in 13 cases （ ovarian cystectomy in 11 and myomectomy in 2） with the assistance of hysteroscopic resectoscopy, two trocars were employed in 27 cases （ ovarian cystectomy in 11 and myomectomy in 16 ） , and three trocars in 18 cases （ ovarian cystectomy in 9, myomectomy in 5, LAVH in 3, and salpingectomy in 1 ）. The instruments employed in this study were purchased from Daoke Co. Results All of the 58 surgeries were successfully completed. In the patients received ovarian cystectomy, the mean intraoperative blood loss was （46.8 ± 10. 1 ） ml （ranged from 10 to 200 ml）, and the mean operation time was （66. 3 ± 6.7） min （30 -150）. While in the patients underwent myomectomy, the mean intraoperative blood loss was （94.3±8.2） ml （10-400）, and the mean operation time was （104.3±6.7） min （60-180）. For the 3 cases of LAVH, intraoperative blood loss was 100, 200, and 150 ml;and operation time was 255, 240, and 135 min, respectively. The salpingectomy was finished within 30 min. None of the 58 patients developed complications during and after the operations. They were discharged from the hospital in （7.9 ± 1.6） days, and were followed up for 3 to 6 months, during which no complications occurred. Conclusions Gasless laparoscopic surgery is safe, effective, and minimally invasive for gynecological diseases. The procedure can be used for eldly patients and those who cannot tolerate general anesthesia due to cardiovascular diseases.