单、双极电凝联合应用于腹腔镜全子宫切除136例

Application of Monoploar and Bipolar Coagulation in Total Laparoscopic Hysterectomy: Report of 136 Cases

目的探讨普通器械联合应用于腹腔镜全子宫切除术（total laparoscopic hysterectomy,TLH）的安全性和效果。方法 2007年6月~2009年10月采用杯形举宫器,单、双极电凝等常用腹腔镜器械行TLH136例。结果 136例均于腹腔镜下完成手术,无一例中转开腹。114例行单纯子宫切除,22例同时行下列手术：单侧或双侧附件切除5例,卵巢囊肿剥除9例,盆腔粘连松解12例,腹腔镜胆囊切除术2例。手术时间（95.6±15.4）min,术中出血量（80.7±23.4）ml。术后住院4~5d,术中及术后均未出现并发症。136例随访3个月,5例术后14~18 d阴道有少许血性分泌物,阴道上药2~3次好转,其余病例术后无异常。结论腹腔镜普通器械联合应用于TLH,能有效防止膀胱、输尿管、肠道等的损伤,使用单、双极电凝、杯形举宫器操作简单、经济。

Objective To investigate the effectiveness and safety of routine surgical instruments for total laparoscopic hysterectomy（TLH）. Methods From June 2007 to October 2009 we performed TLH on 136 cases,during the procedure,uterus lifting cup,and monopolar or bipolar electrocoagulation were employed.Results The laparoscopic hysterectomy was completed in all of the 136 cases without conversion to open surgery.Among the patients,simple hysterectomy was performed on 114 cases,while in the other 22 patients,the following procedures were carried out simultaneously： unilateral or bilateral adnexectomy（5 cases）,ovarian oophorocystectomy（9 cases）,adhesiolysis（12 cases）,and cholecystectomy（2 cases）.The mean operation time was（95.6±15.4） min,and intraoperative blood loss was（80.7±23.4）ml.The patients were discharged from hospital in 4 to 5 days after the operation.No complications occurred during and after the treatment.The 136 patients were followed up for three months,5 of them had slightly bloody secretions in 14 to 18 days postoperative,and then was cured by topical treatment.Conclusions Routine surgical instruments including monopolar and bipolar electrocoagulation and uterus lifting cup are effective,safe,and economic in avoiding injuries to the bladder,ureter and intestine during TLH.