微型小头弯分离钳在妇科腹腔镜手术中的应用

Clinical Application of Micro-head Separating Forceps in Laparoscopic Gynecological Operations

目的评价微型小头弯分离钳在腹腔镜下输卵管吻合术,输卵管伞端造口术,输尿管隧道处理3种术式的临床应用的价值。方法实验组应用微型小头弯分离钳在腹腔镜下行输卵管吻合术(18例),输卵管伞端造口术(22例)和输尿管隧道处理(28例),对照组使用常规器械,其中输卵管吻合术(16例),输卵管伞端造口术(20例),输尿管隧道处理(26例)。结果输卵管吻合术:实验组手术时间(58.7±9.2)min,明显短于对照组(77.9±9.6)min(t=-5.951,P=0.000);输卵管通畅率明显高于对照组(Fisher’s检验,P=0.000)。输卵管伞端造口术:实验组手术时间(49.6±5.2)min,明显短于对照组(65.5±6.6)min(t=-8.713,P=0.000);输卵管通畅率明显高于对照组(Fisher’s检验,P=0.043)。输尿管隧道处理:实验组手术时间(35.7±5.3)min,明显短于对照组(52.9±5.4)min(t=-11.808,P=0.000);术中出血量(10.4±4.4)ml,明显少于对照组(18.1±8.4)ml(t=-4.263,P=0.000);术后输尿管损伤率、宫旁切除范围2组均无明显差异(Fisher’s检验,P=0.227;t=1.797,P=0.078)。结论腹腔镜下输卵管吻合术和输卵管伞端造口术中应用微型小头弯分离钳,操作更加简便、快捷,缩短手术时间,术后输卵管通畅率高,适用于所有输卵管复通及输卵管伞端阻塞患者的手术;输尿管隧道处理应用微型小头弯分离钳可缩短手术时间,减少手术出血量,值得临床推广。

Objective To explore the clinical application of micro-head forceps in laparoscopic fallopian tube anastomosis , tubal umbrella end colostomy , and ureter tunnel management in Piver Ⅲ radical hysterectomy . Methods Micro-head separating forceps were used in the experimental group , including laparoscopic tubal anastomosis （18 cases）, tubal umbrella end colostomy （22 cases）, and type Piver Ⅲradical hysterectomy ureter tunnel operation （28 cases）.Conventional instruments were used in the control group, including fallopian tube anastomosis （16 cases）, tubal umbrella end colostomy （20 cases）, and ureter tunnel treatment （26 cases）. Results For fallopian tube anastomosis, the operation time was significantly shorter in the experimental group （58.7 ± 9.2） min than that in the control group （77.9 ±9.6） min （t=-5.951, P=0.000）, and the tubal patency rate was significantly superior in the experimental group than that in the control group （Fisher’s test, P=0.000）.For tubal umbrella end colostomy, the operation time was significantly shorter in the experimental group （49.6 ±5.2） min than that in the control group （65.5 ±6.6） min （t=-8.713, P=0.000）, and the tubal patency rate was significantly superior in the experimental group than that in the control group （Fisher’s test, P=0.043）.For ureter tunnel management , the operation time was significantly shorter in the experimental group （35.7 ±5.3） min than that in the control group （52.9 ±5.4） min （t=-11.808, P=0.000）, the intraoperative blood loss was significantly less in the experimental group （10.4 ±4.4） ml than that in the control group （18.1 ±8.4） ml （t=-4.263,P=0.000）, and no significant differences were noted between the two groups in ureteral injury rate and uterine resection range （Fisher’s test, P=0.227;t=1.797, P=0.078）. Conclusions Use of micro-head separating forceps in laparoscopic tubal anastomosis and tubal umbrella end colostomy has advantages of simple performance , short operation time , less complications , and high postoperative pregnancy rate , applicable to all fallopian tube recanalization and tubalumbrella end obstruction .Use of micro-head separating forceps in the treatment of ureteral tunnel in Piver Ⅲ type radical hysterectomy can reduce injury of the ureter , shorten operation time , and reduce blood loss during operation , being worthy of clinical application .