协和医学杂志

2011, v.2(02) 134-138

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改良腹腔镜子宫切除术的临床结局
Clinical Outcomes of Modified Laparoscopic Hysterectomy

谭先杰;吴鸣;马水清;
TAN Xian-jie,WU Ming,MA Shui-qingDepartment of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy ofMedical Sciences & Peking Union Medical College,Beijing 100730,China

摘要(Abstract):

目的探讨腹腔镜子宫切除术(laparoscopic hysterectomy,LH)某些改良操作的临床价值。方法 分析北京协和医院2007年6月至2008年5月71例改良腹腔镜子宫切除术(modified laparoscopic hysterectomy,MLH)的手术特点、子宫大小、手术时间、出血量、并发症,并与同期28例完全腹腔镜子宫切除术(total laparoscopic hysterectomy,TLH)和36例腹腔镜辅助阴式子宫切除(laparoscopic assisted vaginal hysterectomy,LAVH)进行比较。结果 与TLH和LAVH组比较,MLH组改良措施主要包括经阴道(而不经腹腔镜)缝合残端、使用LH专用举宫器、使用百克钳代替传统双极电凝、在子宫被离断前经腹腔镜用电动粉碎器完成缩减子宫体积操作(腹腔镜下原位缩减)。MLH、TLH和LAVH组子宫大小(均值)分别相当于妊娠(12.3±2.6)、(10.3±1.9)和(11.6±2.2)周,分别有39例(54.9%)、3例(10.7%)和18例(50.0%)需缩减子宫体积,MLH组与TLH组比较差异有统计学意义(P<0.01)。MLH平均手术时间为78.0min,短于TLH和LAVH组的90.4和94.7min(P<0.05);MLH、TLH和LAVH组术中估计平均出血量分别为81.3、81.1和144.2ml,LAVH组明显多于MLH和TLH组(P<0.05)。MLH、TLH和LAVH组术后病率分别为16.9%、10.7%和13.9%,MLH组与TLH组比较差异有统计学意义(P=0.0439)。MLH组和LAVH组各发生1例输尿管损伤,TLH组1例发生阴道残端出血。结论 LH专用举宫器和百克钳的使用能提高LH的可操作性;腹腔镜下原位缩减子宫体积法是一种可选方法 ;经阴道缝合阴道残端比经腹腔镜缝合简便,尤其适用于需经阴道缩减子宫体积者。
Objective To investigate the clinical significance of modified laparoscopic hysterectomy(MLH).Methods Totally 71 patients received MLH in our hospital from June 2007 to May 2008.Their procedure characteristics and clinical outcomes including surgery duration,intra-operative blood loss,and complications were compared with those of 28 patients who received total laparoscopic hysterectomy(TLH)and 36 patients who received laparoscopic assisted vaginal hysterectomy(LAVH)during the same period.Results Compared with TLH and LAVH group,the main modifications in MLH group included:suturing the vaginal vault via vaginal approach instead of laparoscopic approach;use of special uterus manipulator and novel electronic coagulation equipment(Biclamp);and reducing uterine volume with electric comminuter via laparoscopy before the circular amputation of vaginal wall(i.e in situ volume reduction)instead of reducing manually via vaginal approach.The mean uterine sizes in MLH,TLH,and LAVH group were equivalent to the gestational ages of(12.3±2.6),(10.3±1.9),and(11.6±2.2)weeks,respectively.Uterine volume reduction procedure was performed in 39 patients(54.9%)of MLH group,3 patients(10.7%)of TLH group,and 18 patients(50.0%)of LAVH group,obviously,there was a significant difference between MLH and TLH group(P<0.05).The mean surgery duration was 78.0 min in MLH group,which was significantly shorter than those in TLH group(90.4 min)and LAVH group(94.7 min)(both P<0.05).The mean intra-operative blood loss was significantly higher in LAVH group(144.2 ml)than in MLH(81.3 ml)and TLH group(81.1 ml).The post-operative morbidity rate was 16.9%,10.7%,and 13.9% in MLH,TLH,and LAVH group;obviously,there was a significant difference between MLH and TLH group(P=0.0439).One patient from MLH group and one patient from LAVH group experienced ureter injury,and one patient form TLH group suffered from post-operative vaginal vault bleeding.Conclusions The use of special uterus manipulator and novel electronic coagulation equipment improves the feasibility of laparoscopic hysterectomy.In situ uterine volume reduction via laparoscope is an alternative method for uterine volume reduction.Suturing vaginal vault through vaginal approach is more practical than laparoscopic approach,especially for patients whose uterus volume needs to be reduced vaginally.

关键词(KeyWords): 腹腔镜子宫切除;全腹腔镜子宫切除;腹腔镜辅助阴式子宫切除;操作技巧
laparoscopic hysterectomy;total laparoscopic hysterectomy;laparoscopic assisted vaginal hysterectomy;procedure skill

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作者(Author): 谭先杰;吴鸣;马水清;
TAN Xian-jie,WU Ming,MA Shui-qingDepartment of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy ofMedical Sciences & Peking Union Medical College,Beijing 100730,China

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