腹腔镜下大子宫全切除术168例临床分析

Clinical Analysis about 168 Hysterectomia of Big Uterus in Laparoscopic Operation

目的：探讨腹腔镜下大子宫全切除术的最佳适应证、效果、安全性及手术操作技巧。方法：选择我院2009年1月至2013年1月收治的行大子宫全切除术的患者236例,其中168例行腹腔镜下子宫全切除术（TLH组）,68例行开腹子宫全切除术（TAH组）,比较两种手术术中、术后情况及手术适应证。结果：子宫大小在12-14周者TLH组明显多于TAH组,分别占45.2%与20.6%（P〈0.01）。两组手术时间比较差异无统计学意义（P〉0.05）,术中出血量TAH组（166.2±68.6 ml）多于TLH组（102.6±48.6 ml）,手术近期并发症腹部切口感染TAH组（5.9%）多于TLH组（0.6%）,两组比较差异均有统计学意义（P〈0.05）。术后病理检查均为良性病变,4例富于细胞型平滑肌瘤经随访1-5年均无复发。结论：腹腔镜下大子宫全切除术在选择合适的置镜位置,在镜下离断圆韧带、卵巢固有韧带及子宫动脉上行支后,及时移除影响深部操作的大子宫体的情况下是安全、可行的,不会增加手术危险性和手术并发症,但对术者除要求具备丰富的镜下手术经验外,还要对患者子宫大小和肌瘤的性质进行综合评估。

Objective： To explore the indications and surgical technique of hysterectomia of big uterus by laparoscopy. Methods： The clinical data of 236 hysterectomias of big uterus from Jan 2009 to Jan 2013 in our hospital were retrospectivly analyzed. Among which,168 cases undergone laparoscopically total hysterectomias（ TLH group）,68 cases undergone abdominal total hysterectomies（ TAH group）. The operation,post-operation condition,and operation indication were compared between these two groups. Results： The number of large size of uterus between 12 to 14 gestational week in group（ 45. 2%） more than TAH group（ 20. 6%）（ P〈0. 01）. There was no significant difference on operation time between these two groups（ P〈0. 05）. The bleeding volume in TAH group（ 166. 2 ±68. 6 ml） was more than that in TLH group（ 102. 6 ±48. 6 ml）（ P〈0. 05）,abdominal incision infection ratioin in TAH group（ 5. 9 %） was higher than that in TLH group（ 0. 6 %）（ P〈0. 05）. Post-operation pathological examination showed that all the cases were benign lesion. Four cases with cytotype leiomyoma were without recurrence after 5years fol ow up. Conclusions： It is safe and feasible to choose the right rear lens aperture,mutilate round ligament,ovarian inherent ligament,and uterine artery ascending branch,timely remove big uterine body effecting deep operating in laparoscopic hysterectomy,which wil not increase surgical risk and operation complication,however,the operation requests affluent operation experience,and comprehend evaluation about operation indcation and myomatous nature.