腹腔镜联合手术在普外科及妇科中的应用价值

The Clinical Value of Combined Laparoscopic Cholecystectomy for General and Gynecologic Surgery

目的探讨普外科行腹腔镜胆囊切除同期行妇科子宫及附件联合手术的可行性和优势。方法 2009年1月-2013年12月普外科和妇科选择35～55岁中年女性胆囊结石合并子宫肌瘤、卵巢囊肿、输卵管粘连等妇科良性疾病患者60例,入选条件胆囊结石,胆囊壁厚〈0.5 cm,非急性炎症期,妇科疾病均有症状,瘤体5.0～10.0 cm。在年龄、体质（胖瘦）、病理类型大致相同对比情况下,根据患者的意愿分为腹腔镜联合手术（GLS）组和分期手术组（对照组）,观察比较两组麻醉时间、手术时间、腹壁戳孔数、住院时间、总费用等情况。结果 CLS组均一次手术成功,术后肝功能异常2例,分别经保肝治疗5～6 d恢复正常。对照组二次手术时2例因脐部及腹腔粘连中转开腹;两组患者无切口感染,无医源性组织器官损伤,均治愈出院。CLS组在麻醉时间、手术时间、腹壁戳孔数、住院时间、费用较对照组有明显优势,两组比较差异有统计学意义（P〈0.05）。结论在胆囊结石联合妇科手术方面,GLS安全可行、美观、经济、实用。

Objective To investigate the feasibility and advantages of general laparoscopic cholecystectomy and gynecologic uterus and attachment surgery at the same time. Methods Sixty patients with gallbladder stones combined with ovarian cysts, benign gynecological disease or fallopian tube adhesions aged between 35 and 55 were chosen from the department of General Surgery and Gynecology and Obstetrics to be the study subjects between January 2009 and December 2013. The inclusion criteria included： gallbladder stones; gallbladder wall thickness 〈 0.5 cm; non-acute inflammation; symptomatic gynecological diseases; and tumor size between 5.0 and 10.0 cm. Based on similar age, body mass, and histological type, the patients were divided into laparoscopic surgery （GLS） group and staging surgery group （control group） according to the will of the patients. The anesthesia time, surgery time, the number of abdominal perforations, length of hospital stay, and total costs were detected for comparison between the two groups. Results The first-time operation was successful in all the patients in the CLS group, with two cases of abnormal liver function, which were cured within 5-6 days. In the control group, 2 cases of reoperation were transferred to laparotomy due to umbilical and peritoneal adhesions, and both of them were cured and discharged from hospital without incision infection or iatrogenic tissue and organ damage. CLS group had significant advantages in anesthesia time, surgery time, the number of abdominal perforations, length of hospital stay, and total costs over the control group （P 〈 0.05）. Conclusion The combined gynecologic laparoscopic surgery is feasible, safe, mini-invasive, and economical.