腹腔镜子宫切除术式的研究

Study on two techniques of laparoscopic surgery on hysterectomy.

目的:总结腹腔镜子宫切除术的临床价值。方法:在腹腔镜下对330例患者施行子宫切除术,与170例剖腹术进行比较,就术式选择、手术优越性、适应证、并发症进行对比分析。结果:腹腔镜辅助的经阴道子宫切除术式(LAVH)受子宫大小及膀胱反折腹膜粘连的影响,适用于子宫小于16孕周尤其是临床高度怀疑子宫肌瘤或内膜恶变患者。腹腔镜筋膜内宫颈上子宫切除术(CISH)可保持阴道及盆底正常解剖结构的完整性,切除宫颈癌的好发部位,而且手术受子宫大小及其与周围粘连的限制少。腹腔镜施行子宫手术具有术中出血量少及手术时间不延长、术后病率低、住院时间短、术后恢复快等优点。结论:腹腔镜子宫切除手术具有微创、效优的特点,值得临床推广使用。

Objective:To summrize the clinical significancy of different technique of gynecological laparoscopic surgery on hysterectomy. Methods: 330 patients with different gynecological diseases were treated with laparoscopy hysterectomy and were compaired with 170 patients that were treated with transabdomynal hysterectomy. The different forms of technique were performed for the different surgical indication of these cases, which were analysed for the condition of intraoperation and postoperation, the superiority, indication and complication. Results: The laparoscopy assisted vaginal hysterectomy (LAVH) were limited by the uterine size and the adhesion of peritoneal fold LAVH was suitble for patients with the uterus less than pregnant 16 weeks size, especially when suspicion of malignancy of the uterus or endometrium. Classical intrafascial supracervical hysterectomy (CISH) might preserve the intact of normal pelvic anatomy and for section of the entire transformation zone which area easily affected of cervical carcinoma, also no limitation of the uterine size. The laparoscopic hysterectomy would provide an advantage of less intraoperative bleeding with no longer operation time, less morbidity, shorter hospitalization period and rapid recovery. Conclusions: Laparoscopic surgery is worthy of being advocated owing to its benefit.