悬吊式经脐入路腹腔镜辅助阴式子宫切除术的临床分析(附32例报告)

Clinical analysis of suspended transumbilical laparoscopic-assisted vaginal hysterectomy: with a report of 32 cases

目的：探讨悬吊式经脐入路腹腔镜辅助阴式子宫切除术的应用价值。方法：回顾分析为32例子宫、宫颈良性病变患者行悬吊式经脐腹腔镜辅助阴式子宫切除术的临床资料。结果：4例因盆腔空间狭小辅助低气腹（压力8mmHg）完成手术，余均顺利完成悬吊式经脐腹腔镜辅助阴式子宫切除术。手术时间75～130min，平均（95±8）rain；术中出血量50-160m1．平均（110±10）ml；术后肛门排气时间〈6h8例，6～12h19例，12～24h5例。4例术后48h内体温〉37．5℃。均无肩胛疼痛、出血及邻近脏器损伤等并发症发生。术后住院4—6d，平均（5．2±0．4）d。结论：悬吊式经脐入路腹腔镜辅助阴式子宫切除术是安全、可行的，具有并发症少、微创美观等优点，更符合微创经自然腔道手术的理念；但受手术空间暴露、术者技术水平等因素的影响，选择病例时应全面评估患者的子宫大小、阴道条件，尽量避免有盆、腹腔手术史的患者，以减少手术并发症的发生。

Objective：To discuss the application value of suspended transumbilieal laparoscopic-assisted vaginal hysterectomy. Methods ： The clinical data of 32 patients （ uterine or cervical benign lesions） undergoing suspended transumbilical laparoscopic-assis- ted vaginal hysterectomy were retrospectively analyzed. Results：Low pneumoperitoneum （the CO2 pressure was 8 mmHg） was used in 4 cases because of small pelvic space. The other operations were successfully performed. The operation time was 75-130 rain, （95 ± 8） rain on average. The intraoperative hemorrhage was 50-160 ml, （ 110 ± 10） ml on average. The exhaust time was less than 6 h in 8 cases,6 h to 12 h in 19 cases,and 12 h to 24 h in 5 cases. The postoperative body temperature within 48 h was higher than 37.5% in 4 cases. No postoperative complications such as scapular pain, bleeding or adjacent viscera injury occurred. The postoperative hospital stay was 4-6 d, （5.2 ±0.4 ） d on average. Conclusions：Suspended transumbilical laparoscopic-assisted vaginal hysterectomy is a safe and feasible approach with few complications, minimal invasion, and cosmetic effect, which conforms to the concept of mini-invasive nat- ural orifice transluminal endoscopic surgery. However, due to small surgical field and other difficulties during surgery, patients should be chosen carefully. The size of uterus and conditions of vagina should be fully assessed, patients with operation history of abdominal and pelvic cavity should not be involved in this procedure, in order to decrease the incidence of operative complications.