改良腹腔镜下大子宫全切除160例报告

Modified Laparoscopic Hysterectomy for Patients with Large Uterus: Report of 160 Cases

目的探讨腹腔镜下巨大子宫全切除术的安全性及手术技巧。方法回顾性分析2005年1月~2010年1月160例子宫12~18孕周行改良腹腔镜下全子宫切除术的临床资料。置镜位置在宫底上至少3 cm。使用自制加长举宫器;处理完双侧附件后即下压子宫体打开子宫膀胱腹膜反折,下推膀胱后向两侧分离阔韧带,游离子宫动静脉约0.8~1 cm后离断;阻断子宫血管后先旋切大部分宫体。结果 160例全部在腹腔镜下完成手术,无一例中转开腹。1例术中皮下气肿,余无严重并发症发生。平均手术时间90.8 min（86~138 min）,术中出血量103.8 ml（70~302 ml）,术后住院时间4.2 d（4~5d）。160例随访3~6个月,无术后并发症。结论选择合适的置镜孔,选择加长举宫器,处理好附件及子宫血管,子宫旋切器粉碎出大部分子宫体,腹腔镜下巨大子宫全切除术是安全、可行的,不会增加手术危险性和手术并发症。但要求术者具备丰富的镜下手术经验。

Objective To investigate the safety and techniques of laparoscopic hysterectomy for patients with large uterus.Methods We analyzed the clinical records of 160 patients with large uterus（size,12-18 gestational weeks）,who underwent laparoscopic hysterectomy in our hospital from January 2005 to January 2010.An operational trocar was placed at 3 cm above the uterus bottom.With a self-designed lengthened uterus lifting cup,after dealing with the bilateral adnexa,we pressed down the uterine body to open the vesticouterine fold of the peritoneum,and then separated the broad ligament by pushing the bladder backwards.Afterwards,the uterine vessels were separated and cut at 0.8 to 1.0 cm to remove the uterine body.Results The procedures were completed in all the 160 patients with laparoscopy without conversion to open surgery.The mean operation time was 90.8 minutes（ranged from 86 to 138 minutes）,and intraoperative blood loss ranged from 70 to 302 ml（103.8 ml）.In the patients,no serious complications occurred after the operation,except for one case of subcutaneous emphysema.The mean hospital stay was 4.2 days（4-5 days）.The patients were followed up for 3 to 6 months,during which no postoperative complications occurred. Conclusions Laparoscopic hysterectomy is safe and feasible for patients with large uterus,as long as the trocar is properly placed,the adnexa and uterine vessels are well handled,and the operators are experienced.