腹腔镜辅助阴式子宫全切除术12例分析

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1、腹腔镜辅助阴式子宫全切除术12例分析腹腔镜辅助阴式子宫全切除术12例分析【摘要】 目的：探讨腹腔镜辅助阴式子宫全切除术的效果及手术要点。方法：对例子宫肌瘤、腺肌瘤、子宫内膜轻度不典型增生等有子宫切除指征的患者行腹腔镜辅助阴式子宫全切除术。结果：手术均获成功，无中转开腹。平均手术时间105min（90200min），术中平均出血0ml(100300ml)，术后住院46d。结论：腹腔镜辅助阴式子宫全切除术患者创伤小，肠道干扰少，康复快。手术关键是适应证选择合适及术者有丰富的操作经验。 【关键词】 子宫切除术 阴道式 腹腔镜术Clinical analysis of patients receive

2、d laparoscopic assisted vaginal hysterectomy【Abstract】 Objective:To investigate the effect and main points of laparoscopicassisted vaginal hysterectomy(LAVH).Methods：Twelve patients with uterine myoma,adenomyoma,and light atypical hyperplasia of endometrium underwent LAVH.Results:All cases were succ

3、essfully performed,none of them were converted to laparotomy.The average operating time was 105min(90200min),the average blood loss was 0ml(100300ml),and the hospitalization after operation was 46d.Conclusions:LAVH has the advantages of minor damage,little interference to intestinal and quickly reco

4、very.The key of LAVH is strictly control of indication and rich experiences of operation.【Key words】 Hysterectomy,vaginal;Laparoscopy2005年9月至2006年8月我们为例患者施行了腹腔镜辅助阴式子宫切除术（laparoscopicassisted vaginal hysterectomy,LAVH），现报道如下。1 资料与方法1.1 临床资料 例患者平均46岁（3760岁）。平均69Kg（4794Kg），经阴道分娩平均2次。子宫肌瘤8例，子宫腺肌瘤2例，子宫内膜

5、轻度不典型增生2例。例均无下腹部手术史。子宫体积如孕10周5例，如孕610周5例，正常大2例。病例选择标准：（1）经宫颈刮片、诊刮等排除恶性肿瘤；（2）子宫体积小于如孕周；（3）估计盆腔无严重粘连；（4）阴道松弛、弹性好。1.2 手术方法 全麻4例，腰麻联合硬膜外麻醉8例。麻醉成功后，患者取膀胱截石位。放置举宫器及气囊导尿管，于脐孔上缘做一10mm切口，置入Trocar，充入CO2气体，腹腔压力为1013mm Hg,形成气腹后患者取头低臀高位，置入腹腔镜，根据宫底高度及子宫形态于下腹两侧相应部位穿刺5mm Trocar为操作孔，置入手术器械。双极电凝离断双侧圆韧带、卵巢固有韧带及输卵管峡部，分离膀胱腹膜返折并剪断下推膀胱。按阴式子宫切除术经阴道处理子宫主韧带、宫骶韧带及子宫动脉血管，子宫全部游离后，从阴道内向外牵拉子宫并从阴道取出，经阴道连续内翻缝合盆底腹膜及阴道残端粘膜，腹腔镜下冲洗盆腔，检查无渗血后，拔镜放气，缝合各穿刺孔。