腹腔镜子宫切除术四种术式适应证的选择

How to select a best way in 4 types of laparoscopic hysterectomy

目的探讨腹腔镜子宫切除术4种术式适应证的选择。方法将腹腔镜子宫切除术的4种术式患者分为3组,每组60例,记录每种术式患者的年龄、诊断、妇科检查情况、平均手术时间、平均术中出血量及手术并发症,并进行总结分析。结果腹腔镜次全子宫切除术(LSH)组患者平均42.5岁,疾病种类为子宫肌瘤、子宫腺肌症,宫颈无病变或病变程度轻,平均手术时间为78.23min,平均术中出血量为72.81ml,平均手术并发症发生率为0%。腹腔镜鞘膜内子宫切除术(CISH)组患者平均45.8岁,仍以子宫肌瘤及子宫腺肌症为主要疾病种类,宫颈存在一定程度的病变,但可排除恶性可能。其平均手术时间为95.72min,平均术中出血量为100.12ml,平均手术并发症发生率为5%。腹腔镜全子宫切除术/腹腔镜辅助阴式子宫切除术(LTH/LAVH)组患者平均51.7岁,除了子宫肌瘤及子宫腺肌症患者外,还包括了宫颈/子宫内膜癌前病变或早期癌变的患者。其平均手术时间为118.28min,平均术中出血量为171.68ml,平均手术并发症发生率为3.33%。结论应根据患者的年龄、疾病种类、宫颈病变情况进行综合分析,选择手术方式。

Objective To study on how to select a best way in 4 types of laparoscopic hysterectomy.Methods All the patients were divided into 3 groups according to types of laparoscopic hysterectomy,and every group has 60 patients.Patient’s age,diagnosis,gynecologic examination,average operation’s time,average bleeding during operation and the operation’s complications in every group were analyzed to find out the regulation on the selection of the operation methods.Results Patients in LSH group the average age is 42.5,mainly are uterine myomas and adenomyomas and have no cervical lesions or have slight cervical lesions.The average operation’s time is 78.23 min and the average bleeding during operation is 72.81ml.The average rate of the operation’s complications is 0%.In CISH group patient’s average age is 45.8.The main diagnosis is uterine myomas and adenomyomas.Cervical lesions will be exist and exclude malignant changes.The average operation’s time is 95.72 min and the average bleeding during operation is 100.12ml.The average rate of the operation’s complications is 5%.In LTH/LAVH group patient’s average age is 51.7.Besides uterine myomas and adenomyomas,it also includes early malignant changes in the cervical and the uterine.The average operation’s time is 118.28 min and the average bleeding during operation is 171.68ml.The average rate of the operation’s complications is 3.33%.Conclusion To select which type of laparoscopic hysterectomy depends on patient’s age,diagnosis and the lesions in the cervical.