腹腔镜子宫肌瘤剔除术中经阴道后穹隆取瘤法的应用效果

Application effect of transvaginal posterior fornix removing of myoma of uterus during laparoscopic myomectomy

目的:探讨多孔腹腔镜子宫肌瘤剔除术后经阴道后穹隆取标本的安全性和有效性。方法:收集2020年9月-2022年8月在贵州省安顺市人民医院妇科行腹腔镜子宫肌瘤剔除术患者42例临床资料,采用经阴道后穹隆取瘤法取出标本。手术常规瘤体挖除缝合子宫后,经脐孔穿刺器置入普通标本袋,将瘤体装入袋中,横形切开阴道后穹隆约30mm,直视下经道阴道后穹隆切口牵出,拉出阴道口在袋内缩减取出,腹腔镜下缝合阴道后穹隆切口。结果:42例手术均顺利完成,手术时间191.2±171.4min,自置入标本袋开始计时直至取出瘤体为取瘤时间为7.7±5.3min,阴道后穹隆缝合时间3.4±0.5 min,挖除肌瘤个数2.44±1.83枚,瘤体最大直径65.83±19.62mm,其中粘膜下2例、肌壁间37例、特殊部位3例,总出血量为191.2±171.4ml。术后病理证实为子宫平滑肌瘤40例、子宫腺肌瘤2例,阴道感染病例2例,无直肠损伤病例发生;术后随访11.6±3.4个月,阴道后穹隆切口愈合良好,生活无不适。结论:经阴道后穹隆取瘤法经济快捷、安全可行,值得在临床应用。

Objective:To investigate the safety and effectiveness of transvaginal posterior fornix removing of myoma of uterus during multihole laparoscopic myomectomy.Method:The clinical data of 42 patients who underwent laparo-scopic myomectomy from September 2020 to August 2022 were collected,and their myoma of uterus were removed by transvaginal posterior fornix.After conventional removing myoma and suturing of the uterus,the myonpa was placed into a common specimen bag which had inserted through the umbilical puncture device,and the myoma was put into the bag.Then the posterior vaginal fornix of the patients was cut transverse for about 30mm,and the specimen bag with myoma was pulled out through the vaginal posterior fornix under direct vision after the myoma reduced,and the incision of the vaginal posterior fornix was sutured under laparoscopy.Results:All 42 patients had completed the operation successfully,and the operation time of the patients was 191.2±171.4 min,the time from the myoma putting in the specimen bag to the myoma tumor removal was 7.7±5.3 min,the suture time of the vaginal posterior fornix incision was 3.4±0.5 min,and the number of myoma removed was 2.44±1.83 pieces.The maximum diameter of the myoma was 65.83±19.62 mm.The removed myoma included 2 pieces of submucosa myoma,37 pieces of intermuscular wall myoma,and 3 pieces of special sites myoma.The total blood loss of the operation was 191.2±171.4ml.There were 40 patients with uterine leiomyoma and 2 patients with uterine adenomyoma confirmed by postoperative patholo-gy.There were 2 patients with vaginal infection,and there was no any patient with rectal injury during operation.All the patients were followed up for postoperative 11.6±3.4 months and the incisions of the vaginal posterior fornix of all the patients healed well without any discomfort.Conclusion:Transvaginal posterior fornix removing of myoma of uterus during multihole laparoscopic myomectomy is economical and quickly,which is also safe and feasible,and worthy of clinical application.