腹腔镜辅助下阴式全子宫切除术的疗效观察(1)
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2010年2月1日
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【摘要】目的:探讨腹腔镜辅助下经阴道全子宫切除术的临床效果及可行性。方法:将100例子宫良性病变、需全子宫切除术患者根据自愿的原则分为腹腔镜组(LAVH组)56例、阴式组(TVH组)44例。腹腔镜组行腹腔镜辅助阴式全子宫切除术,阴式组行经阴道全子宫切除术。观察两组术中、术后情况。结果:LAVH组手术时间与阴式组比较差异无统计学意义(P>0.05),LAVH组术中出血量、住院时间及术后发热、感染发生率均明显少于阴式组(均P<0.05)。结论:腹腔镜辅助阴式全子宫切除术较单纯阴式更具优势,可广泛推广应用。
【关键词】全子宫切除;腹腔镜辅助阴式全子宫切除术;经阴道全子宫切除术
【中图分类号】R713 【文献标识码】A 【文章编号】1008-6455(2010)08-0161-02
The comparison of different anesthesia approaches in pediatric patients with congenital heart disease undergoing cardiac catheterization
ZhangGuiping Liang Guiling Su Xiaorong Liang Ning’an
【Abstract】Objective:To explore the clinical effect and feasibility of laparoscopic assisted vaginal hysterectomy (LAVH).Methods:100 cases with benign uterus diseases undergoing hysterectomy were randomly divided into laparoscopic assisted vaginal hysterectomy group (group LAVH, n=56) and Vaginal hysterectomy group (group TVH, n=44). In both groups, hospital stay, bleeding loss in the operation, and the incidence of infection, fever was recorded. Results:There was no significant difference in operating time between the two groups (P>0.05). The group LAVH had shorter hospital stay, less bleeding in the operation, and less the incidence of infection, fever than that of the group TVH (all P<0.05).Conclusion:LAVH has obvious advantages to TVH and can be applied safely widely to clinical.
【Key words】hysterectomy; Laparoscopic assisted vaginal hysterectomy; Vaginal hysterectomy
开腹子宫切除术是常见的子宫良性病变的手术方式,随着微创外科理念在妇科领域的引入,以及内窥镜技术的发展,国内外关于子宫良性病变需做子宫全切术式的选择,已逐步向微创手术方向发展[1],阴式子宫切除术(Transvaginal hysterectomy,TVH)和腹腔镜辅助经阴道全子宫切除术(Laparoscopic-assisted vaginal hysterectomy,LAVH)两种术式显示了其在子宫全切除方面的优势[2]。本研究旨对子宫良性病变、需全子宫切除术患者行腹腔镜辅助阴式全子宫切除术进行探讨,并与经阴道全子宫切除术者进行对比,报告如下。
1 资料与方法
1.1 一般资料:选择2008年1月-2010年5月本院住院,术前经妇科检查、阴道超声、宫颈细胞涂片、阴道镜或分段诊刮等检查,均为子宫良性疾病,有全子宫切除术指征患者100例,根据自愿的原则分为两组:LAVH组56例,年龄31～59岁,平均(45.0±5.7)岁;体质量36～68 kg ,平均(49.7±5.2)kg。TVH组44例,年龄33～78岁,平均(45.8±5.1)岁;体质量35～70 kg,平均(49.5±5.0)kg。排除标准:两组均排除子宫大于孕12周、盆腔粘连严重患者和多次手术史者。手术指征为子宫肌瘤、子宫腺肌病、功能失调性子宫出血(功血)、宫颈疾病等。两组患者术前一般情况比较差异无统计学意义(P>0.05),见表1。
1.2 手术方法:LAVH组采用腹腔镜辅助阴式全子宫切除术。应用腹腔镜及相关设备在全身麻醉下取头低臀高位或膀胱截石位,消毒腹部及会阴部皮肤后铺无菌巾,插入16号双腔导尿管。人工气腹。置腹腔镜后检查盆腹腔,明确诊断并评估手术的可行性,再次消毒阴道后暴露宫颈,放置举宫杯,用于摆动子宫。切断子宫圆韧带、输卵管及卵巢固有韧带,如有出血可用单极电凝止血。用超声刀打开阔韧带前后叶腹膜,前方向下达膀胱腹膜反折处,并剪开膀胱腹膜反折并推下膀胱;后方向下分离至子宫骶骨韧带处,将宫旁疏松组织推开即暴露出子宫血管,用电凝将子宫血管凝固,再用超声刀切断子宫血管 ......
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