腹膜后路径在直肠子宫陷凹封闭的腹腔镜全子宫切除术中的应用

Application of Retroperitoneal Approach in Total Laparoscopic Hysterectomy for Patients with Obliterate Posterior Cul-De-Sac

目的探讨腹膜后路径在直肠子宫陷凹封闭的腹腔镜全子宫切除术中的策略方法及其效果。方法对华中科技大学同济医学院附属协和医院2015年1月至2019年6月间所行直肠子宫陷凹封闭的腹腔镜全子宫切除术的临床资料进行分组研究。腹膜后路径组35例,腹膜内路径组40例,比较两组手术和围手术期并发症等情况。结果腹膜后路径组手术时间、术中出血量分别为(115.57±17.23)min、(75.71±40.89)mL,均少于腹膜内路径组[(140.88±18.32)min,(112.57±95.24)mL],差异均有统计学意义(均P<0.05)。两组患者术后体温恢复时间、肛门排气时间和住院时间比较差异均无统计学意义(均P>0.05)。腹膜内路径组有1例中转开腹,1例术中出血量大于500 mL,而腹膜后路径组两者均无。两组均无膀胱、输尿管和肠管损伤。结论应用腹膜后路径对直肠子宫陷凹封闭的患者进行腹腔镜全子宫切除术,术中出血少,解剖层次清晰,未发现输尿管、肠管损伤,效果满意,值得推广。

Objective To explore application and efficacy of retroperitoneal approach in total laparoscopic hysterectomy for patients with obliterate posterior Cul-De-Sac.Methods The clinical data of laparoscopic hysterectomy in patients with obliterated posterior Cul-De-Sac in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,from January 2015 to June 2019,were retrospectively analyzed.There were 35 cases in the retroperitoneal group and 40 cases in the intraperitoneal group.The perioperative outcomes and complications were compared between the two groups.Results The average operation time and estimated blood loss in the retroperitoneal group were[(115.57±17.23)min and(75.71±40.89)mL],respectively,which were significantly less than the intraperitoneal group[(140.88±18.32)min,(112.57±95.24)mL],and the difference was statistically significant(both P<0.05).There were no significant differences in temperature recovery time,anal exhaust time and hospitalization time between the two groups(P>0.05).In the intraperitoneal group,one case was converted to laparotomy,and amount of bleeding was more than 500 mL during operation in one case;while in the retroperitoneal group,neither was found.No bladder,ureter and bowel injury was found in either group.Conclusion This retroperitoneal approach is worthy of promotion for laparoscopic hysterectomy in women with obliterated posterior Cul-De-Sac.The intraoperative bleeding amount was minimal.During surgery,the anatomical landmarks are clear,and no bladder or bowel injury occurred.The effect of this method is satisfactory.