微创型举宫器在腹腔镜下保留盆腔自主神经广泛性子宫切除术中的应用

Microinvasive Uterine Manipulator for Laparoscopic Nerve-sparing Radical Hysterectomy

目的探讨微创型举宫器在腹腔镜下保留盆腔自主神经的广泛性子宫切除术(laparoscopic nerve-sparing radicalhysterectomy,LNSRH)中的临床应用价值。方法 2009年l月～2011年4月,使用微创型举宫器对20例ⅠB～ⅡA期宫颈癌及10例Ⅱ期子宫内膜癌行LNSRH。插尿管后置入举宫器,整个手术过程在腔镜下完成,离断阴道后用举宫器将子宫从阴道拖出。结果手术均获成功,术中无泌尿系损伤。手术时间250～340 min,平均270 min;出血量为50～200 ml,平均110ml;术后拔除尿管时间7～17 d,平均10 d。30例术后随访3～30个月,平均16.7月,所有患者健在,无淋巴囊肿,无肿瘤复发、转移,阴道残端均愈合良好。结论 微创型举宫器有操控简单、能配合高难度妇科腔镜手术、使用过程符合无瘤原则、使用成本低的特点,是行LNSRH的理想手术器械。

Objective To investigate the clinical value of the microinvasive uterine manipulator in laparoscopic nerve-sparing radical hysterectomy（LNSRH）. Methods From January 2009 to April 2011,20 patients with cervical cancer（stage ⅠB-ⅡA） and 10 patients with endometrial carcinoma（stageⅡ）,underwent LNSRH by using microinvasive uterine manipulator.After inserting Foley catheter,we placed the uterine manipulator to remove the vagina after a laparoscopic resection. Results LNSRH was finished successfully in all the cases without urinary injury.The operation time ranged form 250 to 340 min with a mean of 270 min,during which 50-200 ml blood loss was measured（mean,110 ml）.After the operation,the Foley catheter was withdrawn on day 7 to day 17（mean,10 d）.The patients were followed up for 3 to 30 months（mean,16.7 months）.All the patients survived without lymphatic cyst,recurrent tumor,or metastasis;the vaginal stump were healed well in all the cases. Conclusion Microinvasive uterine manipulator is economic and easy to operate,and thus is an ideal choice for LNSRH.