腹腔镜巨大子宫切除术78例体会

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

目的：探讨使用双极电凝行腹腔镜巨大子宫切除术的安全性及手术技巧。方法：回顾分析2006年1月至2007年12月我院为78例子宫超过如孕12周患者行腹腔镜全子宫切除术的临床资料。术中置镜Trocar选在距宫底上至少3-4cm处。手术关键步骤是处理附件及游离子宫血管。结果：78例均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,余均无严重并发症发生。手术时间88-136min,平均112min,术中出血60-266ml,平均158ml,术后平均住院时间（5.1±0.9）d。随访6个月,恢复良好。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巨大子宫切除术经济、安全、可行,不会增加手术危险性和并发症,但要求术者具备丰富的腹腔镜手术经验。

Objective： To investigate the operative safety and skills of laparoscopic hysterectomy of large uterus by using bipolar coagulation. Methods ： The clinical data of 78 cases whose uterus were bigger than twelve gestational age uterus and underwent total laparoscopic hysterectomy from Jan. 2006 to Dec. 2007. The location of laparoscope was at least 3-4cm above the fundus of uterus. The most crucial step was the treatment to adnexa and uterine blood vessels. Results：All laparoscopic operations （78 cases） were performed successfully and no severe operative complications were noticed except for 2 cases of remnant vaginal end inflammation. The average operative time and the intraoperative blood loss were 112min （88-136min） and 158ml （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. Conclusions：Total laparoscopic hysterectomy for large uterus is safe and feasible by using bipolar coagulation, and does not increase operative risk and incidence of complications, when suitable laparoscopic location is selected and treatments of adnexa and uterine vessels are well performed. The operator having rich laparoscopic operative experience is the most important.