腹腔镜辅助阴式子宫全切术临床的应用体会.docVIP

腹腔镜辅助阴式子宫全切术临床的应用体会 　　[摘要] 目的 探讨腹腔镜辅助下阴式子宫全切术的临床疗效和使用价值。 方法 回顾我院有子宫全切手术指征，良性非粘连盆腔患者89例，其中36例行腹腔镜辅助下阴式子宫全切术（LAVH），53例行阴式子宫全切术（TVH），分析对比术中出血量、手术时间、术后镇痛率、出院时间。 结果 两组手术时间、术中出血量、住院时间比较差异无统计学意义，但术后镇痛率有统计学意义。 结论 LAVH扩展了经阴道子宫全切的适应证，同时具有腹腔镜手术的优点，值得推广。 　　[关键词] 阴式子宫全切术；腹腔镜；辅助 　　[中图分类号] R713.42 [文献标识码] B [文章编号] 1673-9701（2012）06-0155-02 　　 　　The clinical application of laparoscopic assisted vaginal hysterectomy 　　LI Zhongrui TAO Chunmei 　　Department of Gynecology and Obstetrics, Heyuan City Maternal and Child Health-Care Hospital, Heyuan 517000, China 　　[Abestract] Objective To study the clinical effects and values of the laparoscopic-assisted vaginal hysterectomy (LAVH). Methods Clinical data about 89 patients of few pelvic adhesion who received LAVH(n = 36) or transvaginal hysterectomy(TVH) (n = 53) were collected and the hospital stay time，operation time，blood loss and the postoperative analgesia rates were compared between LAVH and TVH. Results There was no significant difference of operation time, blood loss and length of hospitalization duration between the two groups. However the postoperative analgesia rates were significantly increased in LAVH(P 0.05). Conclusion In hysterectomy operation, LAVH is safer and has a broader surgical indication than TVH，and is worthy for clinical popularizing and application. 　　[Key words] Through vagina panhysterectomy；Laparoscope；Assist 　　子宫全切术是妇产科常见手术治疗手段，近年来，随着内镜技术的发展及微创观念的深入，腹腔镜辅助阴式子宫全切术（laparoscopic assisted vaginal hysterectomy，LAVH）得以广泛开展。本文现回顾分析我院行LAVH与阴式子宫全切术（trans-vaginal hysterectomy，TVH）的临床资料，现报道如下。 　　1 资料与方法 　　1.1 临床资料 　　2009年10月～2011年10月我院89例患者施行了腹腔镜下阴式子宫全切术（LAVH） 和阴式子宫全切术（TVH）， 其中LAVH36例， TVH53 例。年龄分布：33～54岁，平均（46.0±2.8）岁。LAVH组子宫肌瘤24例，子宫腺肌瘤3例，宫颈CIN 5例，子宫内膜不典型增生2例，功能性子宫出血2例；36例中合并附件病变4例，既往有下腹部手术病史3例（剖宫产、输卵管结扎、阑尾炎各1例）。TVH组中子宫肌瘤28例，子宫腺肌瘤16例，子宫脱垂7例，宫颈中度非典型增生2例，均无既往腹部手术史。 　　1.2 手术方法 　　1.2.1 LAVH组 患者取仰卧位，采用气管插管复合全身麻醉，3孔法（脐部、左右下腹部中外1/3）穿刺，置镜探查盆腔及子宫形态、大小及于周围组织粘连情况，分离粘连，腹腔镜视野下经阴道置子宫固定器，电凝处理并离断双侧子宫圆韧带，卵巢固有韧带及输卵管峡部，切除