腹腔镜超声刀在妇科恶性肿瘤淋巴结切除术中的应用

Role of laparoscopic ultrasonic scalpel in lymphadenectomy of gynecologic malignancies

目的 探讨在妇科恶性肿瘤腹腔镜淋巴结切除术中使用超声刀切割、止血的效果。方法 应用超声刀进行妇科恶性肿瘤腹腔镜盆腔及腹主动脉周围淋巴结切除术共 1 3例 ,其中子宫颈癌 1 0例 ,子宫内膜癌 3例。手术步骤包括经阴道腹腔镜辅助广泛全子宫切除、盆腔及腹主动脉周围淋巴结切除和卵巢动静脉高位结扎。并与同期应用电刀切割和止血的相同术式进行比较。结果 使用超声刀较电刀切割和止血术中出血量明显减少 (P <0 0 5 ) ,手术时间显著缩短 (P <0 0 5 ) ,无术中及术后并发症。结论 腹腔镜下应用超声刀切割和止血具有手术时间短 ,止血效果更佳 ,对周围组织无损伤且并发症少等优点。

Objective To investigate effects of the laparoscopic ultrasonic scalpel and shears on the cutting and hemostasis in lymphadenectomy of gynecologic malignancies. Methods Laparoscopic radial hysterectomy and pelvic or abdominal periaortic lymph node dissection on 13 patients (10 with cervical cancer and 3 endometrial carcinoma) was performed by using a 10 mm ultrasonic scalpel and shears. Surgery operation procedure included laparoscopy assisted vaginal radial hysterectomy, pelvic and periaortic lymph node dissection, and ovaries aortic and vein elevation ligation. Another 17 patients receiving same operation by electric scalpel were served as control to evaluate the cutting and coagulation effects of the objective scalpel. Results Compared with electric scalpel in laparoscopic hysterectomy and lymph node dissection, the objective scalpel and shear had a significantly shorter operation time, less average blood loss and no operation and postoperative complication. Conclusion The use of ultrasonic scalpel and shears in laparoscopic radial hysterectomy and pelvic or periaortic lymph node dissection possesses the advantages of shorter operation time, better homeostasis, no damage to around tissues, and fewer operation complications.