膀胱侧入分离法在膀胱子宫陷凹封闭的腹腔镜下全子宫切除术中的应用

Application of lateral bladder dissection during total laparoscopic hysterectomy with obliterated anterior cul-de-sac

目的对膀胱子宫陷凹封闭的患者采取腹腔镜膀胱侧入分离法进行全子宫切除术的临床疗效进行评价分析。方法对我院2015年1月至2019年1月间腹腔镜下膀胱子宫陷凹封闭的全子宫切除术60例患者,根据下推膀胱的方法分为:侧入组30例,直入组30例,比较两组手术和围手术期并发症情况。结果侧入组的平均手术时间[(108.50±13.59)min]短于直入组[(117.83±14.24)min],差异有统计学意义(P <0.05)。两组患者的术中出血量、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(P>0.05)。直入组1例中转开腹和1例膀胱损伤,侧入组无一例发生。结论对于膀胱子宫陷凹封闭的患者采取腹腔镜膀胱侧入分离法进行全子宫切除术,手术时间短、解剖层次清晰、未发现膀胱损伤、效果满意,值得推广。

Objective To evaluate the safety and efficacy of lateral bladder dissection during total laparoscopic hysterectomy with obliterated anterior cul-de-sac. Methods The clinical data of laparoscopic hysterectomy with obliterated anterior cul-de-sac in our hospital from January 2015 to January 2019 were retrospectively analyzed. There were 30 cases in the lateral bladder dissection group and 30 cases in the central bladder dissection group. The perioperative outcomes and complications were compared between the two groups. Results The operation time was(108.50±13.59) min in the lateral bladder dissection group and(117.83±14.24) min in the central bladder dissection group. The operation time in the lateral bladder dissection group was significantly less than that in the central bladder dissection group, and the difference was statistically significant(P < 0.05). There was no significant difference in estimated blood loss, temperature recovery time, anal exhaust time and hospitalization time between the two groups(P > 0.05). In the central bladder dissection group, one case was converted to laparotomy and one case had bladder injury during operation. While in the lateral bladder dissection group, neither was found. Conclusion Lateral bladder dissection approach is worthy of promotion for laparoscopic hysterectomy in women with obliterated anterior cul-de-sac. The operation time was short. The anatomical landmarks were clear. No bladder injury occurred. And the effect of lateral bladder dissection was satisfactory.