腹腔镜辅助下疤痕子宫阴式全切除术临床分析

Clinical analysis of laparoscopic assisted vaginal hysterectomy for scarred uterus

目的总结应用腹腔镜辅助下阴式疤痕子宫全切除术方法及难点。方法对行腹腔镜辅助下阴式子宫全切除术(laparoscopic assisted vaginal hysterectomy,LAVH)的87例疤痕子宫患者资料及进行回顾性分析,包括术前检查、术中参数、手术路径、疤痕粘连的分离、膀胱意外损伤处理、术后指标等。结果全部病例均成功地进行腹腔镜辅助下阴式子宫全切除术,疤痕子宫组手术时间平均为(128±18)min显著长于非疤痕子宫(92±21)min,两组术中出血量、术后住院时间和病率无显著差异,疤痕子宫组中3例盆腔粘连严重者术中发生膀胱损伤,经处理均恢复正常。结论疤痕子宫患者术前盆腔粘连的正确判断、术中规范的手术操作可减少LAVH术中膀胱损伤概率,其手术难点在于子宫疤痕粘连的分离,子宫膀胱腹膜反折处的处理;膀胱意外损伤的及时发现、正确处理可避免患者二次手术的痛苦。

Objective To review the application of laparoscopic assisted vaginal hysterectomy for scarred uterus.Methods Eighty seven patients with scarred uterus underwent laparoscopic-assisted vaginal hysterectomy（LAVH）.The clinical data of patients were retrospectively analyzed and compared with those of 98 patients with non-scarred uterus,including preoperative examination,operative parameters,surgical path,separation of scar adhesions,management of accidental bladder injury,postoperative indicators.Results Laparoscopic assisted vaginal hysterectomy was performed successfully in all patients.The average operative time of scarred uterus group was significantly longer than that of non scarred uterus group（128 ± 18 min vs 92 ± 21 min,P 0.05）.There were no significant differences in blood loss,postoperative hospital stay and morbidity between two groups.Bladder injury occurred in 3 patients with severe pelvic adhesions in scarred uterus group,which was repaired after treatment.Conclusion The surgical difficulty of LAVH lies in the separation of scarred adhesions and management of uterine visceral peritoneum at processing.Timely detection and appropriate treatment of bladder accidental injury can avoid secondary surgery.