残端宫颈切除术40例临床分析

Clinical analysis of 40 cases with cervical stump resection

目的 探讨次全子宫切除术的指征 ,病理检查对指导手术范围的重要性以及切除残端宫颈的手术技巧。方法 回顾性分析 40例宫颈残端切除术的临床资料。结果 次全子宫切除术时患者平均年龄 (38.9±5 .6 )岁 ,其中良性疾病占 77.5 % ,切除原因有患者要求保留宫颈 ,存在粘连、手术困难等。恶性者占 2 2 .5 % ,切除原因为误诊或手术困难。再次残端宫颈切除手术困难 ,并发症发生率高 (12 .5 % ) ,耗时长。结论 对 40岁以上需切除子宫的多发性子宫肌瘤或子宫内膜异位症者以全子宫切除为佳。行次全子宫切除术前应排除宫颈和内膜恶性病变。术前、术中病理检查可提高恶性肿瘤确诊率 ,以正确选择术式。 [恶性肿瘤手术应彻底 ,必要时先期化疗、放疗或介入治疗。再次残端宫颈切除术难点在于分解粘连、游离输尿管。

Objective To study the indication of subtotal hysterectomy and the importance of pathological examination. Method Forty cases with cervical stump resection were analyzed retrospectively. Results The average age of the patients undergoing subtotal hysterectomy was 38.5±5.6 years. Of them, 77.5% were with benign genital tract diseases (especially myoma ) who received for the reasons of being young (cervix needed), adhesion, or difficulty in operation etc.; 22.5% were with malignant diseases who underwent the speration because of misdiagnosis or adhesion. Results Of cervix stump was difficult, time consuming and with frequent occurrence of complications(12.5%). Conclusion Total hysterectomy is recommended for those who are more than 40 years old and, diagnosed as multiple myoma or endometriosis. Malignant cervical and endometrial diseases should be excluded before subtotal hysterectomy. Pathological examinations are contributed to accurate diagnosis and optimal selection of operation.