腹腔镜手术对妇科疾病诊疗的应用

A clinical application study of 21015cases laparoscopic gynecologic surgery

目的探讨腹腔镜手术在妇科疾病诊治中的临床价值。方法回顾分析武警总医院、武警广州总队和重庆总队三家医院妇科,1995-08至2009-08腹腔镜下妇科各种手术21015例,成功率99.44%(20898/21015)。手术技巧改进,如改良脐部穿刺方法完成卵巢良性肿瘤剔除术;输卵管妊娠开窗取胚术;宫、腹腔镜联合诊治不孕症;"盆腔包块"切除联合腹膜代阴道成形术等。结果完成卵巢良性肿瘤剔除术8148例(≥18 cm巨大囊肿56例);卵巢切除术136例;异位妊娠4645例,输卵管开窗取胚术4387例,切除输卵管258条;腹腔镜下粘连松解、通液输卵管不孕者共4930例,其中宫、腹腔镜联合治疗176例,随访12个月怀孕率为52.76%(86/176)。腹腔镜下完成子宫肿瘤手术3021例,其中肌瘤剔除术418例、LAVH2362例、TLH192例、LASH49例;经阴子宫广泛切除术+盆腔淋巴结清扫21例;慢性盆腔痛粘连分解术69例;腹膜代阴道成形术45例。腹腔镜手术结局均良好。21015例手术中117例中转开腹,占0.56%,中转开腹原因以止血困难、盆腔严重粘连为主。结论腹腔镜手术能够取代90%的妇科开腹手术。

Objiective To evaluate the clinical value of laparoscopic surgery in gynecologic diseases. Methods A total of 21015 cases of laparoscopic surgery in the General Hospital of Chinese People＇s Armed Police Forces ,Guangzhou Corps Hospital and Chongqing Corps Hospital from August 1995 -July 2009 were reviewed, the success rate was 99.44% （20898/21015）. The operation technique was improved. For example , the improved method of puncture was used in the ovarian benign tumor surgery. Surgery of the taking embryo during tubal pregnancy was conducted. Hysteroscopy associated with laparoscopy was used to treat infertility. Peritoneal vaginoplasty was carried out after the＂ pelvic mass＂ resection. Results 8148 cases of ovarian benign tumor surgery were commpished （in 56 cases the tumor ≥18cm）including, 136 cases of casesovariectomy , 4645 cases of tubal pregnancy, 4387 cases of ligation and resection surgery of taking the embryo ,258 fallopian tubes were removed . 4930 cases of Infertility were treated in which 176 cases were treated by Hysteroscopy associated with laparoscopy, and in the following 12 months review, Pregnancy rate is 52.76% （86/176） ;3021 cases of uterus benign tumor surgery were accomplished by laparoscope, in which 418 were Myomectomy, 2362 were LAVH, 192 were TLH, 49 were LASH; 21cases of extensive hysterectomy with pelvic lymph node dissection ,69 cases of chronic pelvic pain and adhe- sion decomposition,45 cases of Peritoneal vaginoplasty; Laparoscopic surgery outcomes are good . 117 cases were transit to abdominal operation, and the transition rate is 0.56%, transit abdominal surgery due to some reasons like difficult stanching bleeding, and severe pelvic adhesion. Conclusion Laparoscopic surgery can substitute 90% of the gynecological abdominal surgery .