腹腔鏡輔助經陰道子宮切除術56例報告

何 菁

[摘要]目的 探討腹腔鏡輔助下經陰道子宮切除術(LAVH)治療子宮肌瘤、子宮腺肌癥及宮頸重度不典型增生的療效。方法 施行腹腔鏡輔助下經陰道子宮切除術56例,首先用腹腔鏡探查及處理腹腔并保存病變,然后在腹腔鏡輔助下經陰道行子宮切除術,最后在腹腔鏡下清洗盆腔。結果 本組56例無一例中轉開腹,也無一例發生術中術后嚴重并發癥,術后隨訪3-24個月,全部患者痊愈。結論 LAVH吸收了傳統的經陰道子宮切除術無腹部切口,腹腔干擾少,并發癥少,術后病率低,恢復快,住院時間短的優點,又摒棄了傳統術式的盲目性,使陰式手術更安全、更精細,并可診斷腹腔并存病變,擴大了手術的適應證。

[關鍵詞] 腹腔鏡;陰道子宮切除;子宮肌瘤

[中圖分類號] R713.4+2 [文獻標識碼] A [文章編號] 1004-8650(2009)06-012-02

[Abstract] Objective To study the curative effect of treating hysteromyoma, myonertrial gland illness and uterine neck non-typical hyperplasia in application of laparoscopically assisted vaginal hysterectomy(LAVH). Methods 56 cases of patients were performed laparoscopically assisted vaginal hysterectomy. Fisrt, celioscope was used to examine and dispose existing celiac pathological changes; then LAVH was undertaken and finally washed and cleaned the abdominopelvic cavity under the celioscope.Results Non case of the 56 cases needed transferring operation on the abdominal cavity, and there was no serious syndrome on any case. Succedent interview in 3-24 months after hysterectomy showed that all patients have recovered.Conclusion Compared to traditional surgery, LAVH achieves better safe result in recovery without cut, fewer syndromes, rapid recovery and less time in hospitalizing. The surgery of LAVH avoids the blindness in traditional open surgery, and makes the surgery much safer and more accurate. It can diagnose existing celiac pathological changes and extends the application of the surgery.

[Key words]Celioscope; laparoscopically assisted vaginal

傳統的經陰道子宮切除術,手術方向是單向的,即由遠端而及近端,存在一定的盲目性。與傳統的經陰道子宮切除術相比,在腹腔鏡輔助下經陰道子宮切除術(LAVH)更安全、更精細,手術適應證更廣泛,逐漸顯示其優勢。我科自2006年10月-2008年10月共施行LAVH56例,現報告如下:

1臨床資料

1.1一般資料

本組56例,年齡43-56歲,平均48.5歲。均為經產婦,分娩1-5次,無子宮脫垂,有下腹手術史7 例,占12.50%,其中2例為腹式輸卵管結扎,2例曾做開腹異位妊娠手術,2例曾行剖宮產術,1例曾行子宮肌瘤剔除術。其中子宮肌瘤34例,子宮腺肌癥9例,子宮肌瘤合并子宮腺肌癥7例,宮頸重度不典型增生2例,子宮肌瘤合并卵巢囊腫4例,均經手術和病理證實。……