腹腔镜Rutledge1型扩大子宫切除术的探讨

Type 1 Rutledge Extended Hysterectomy by Laparoscopy for Cervical Intraepithelial Neoplasia Ⅲ

目的探讨腹腔镜Rutledge 1型扩大子宫切除术的可行性。方法 2009年1月～2011年1月,对23例宫颈锥形切除术病理诊断为宫颈上皮内瘤样病变Ⅲ级的患者实施三孔法腹腔镜Rutledge 1型扩大子宫切除。术中显露但不分离输尿管床,将输尿管偏向外侧,在宫颈筋膜外凝切宫颈膀胱韧带、骶韧带、主韧带,切除阴道1～2 cm。结果 23例均顺利完成手术,手术时间119～184 min(,137±14)min。术中出血量117～233 ml(,159±22)ml。术后保留尿管时间均为2 d,术后住院时间均为4 d。住院期间未发现严重的并发症。23例术后3～4个月随访阴道残端愈合良好,阴道残端液基薄层细胞学检查未见异常。结论腹腔镜Rutledge 1型扩大子宫切除是安全和可行的。

Objective To evaluate the feasibility of laparoscopic Rutledge type 1 extended hysterectomy（extrafascial hysterectomy,LEH） for cervical intraepithelial neoplasia（CIN） Ⅲ.Methods From January 2009 to January 2011,23 cases with CIN Ⅲ received LEH with 3 trocars.In the procedure,the ureters were deviated laterally without being separated,the vesicocervical ligaments,cardinal ligaments and uterosacral ligaments were all excised extrafascially.Meanwhile,1-to 2-cm vaginal tissues was resected.Results LEH were successfully performanced on all the 23 cases within 119 to 184 minutes with a mean of（137±14） minutes,the intraoperative blood loss was 117 to 233 ml [mean,（159±22） ml].The urinary catheter was withdrawn in 2 days after the operation,and the post-operative hospital stay was 4 days in all the patients.No severe complications occurred during the hospital stay.23 patients received follow-up and showed well healed vaginal stump in 3 to 4 months without abnormal results in TCT.Conclusion LEH is feasible and safe for cases with CIN Ⅲ.