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目的探讨因良性疾病或癌前病变行全子宫切除术后卵巢肿物的特点,并总结腹腔镜下手术治疗的技巧。方法收集2005年8月至2013年8月于河北医科大学第四医院因全子宫切除术后盆腔肿物接受手术治疗的132例患者临床资料,对卵巢肿物的良恶性、患者发病年龄以及再次手术与初次手术时间间隔进行分析。结果 132例患者中,卵巢良性肿物94例,占71.21%,其中以卵巢单纯囊肿、卵巢巧克力囊肿多见;恶性肿瘤38例,占28.79%,以卵巢浆液性囊腺癌多见。全子宫切除术后卵巢肿瘤好发年龄为>45~55岁。全子宫切除术后卵巢良性肿物及恶性肿瘤多发生在术后10年内。腹腔镜下手术时,宜注意穿刺孔的选择、粘连的分解以及输尿管位置的改变。结论全子宫切除术后卵巢肿物以良性居多,可以选择腹腔镜探查。手术时套管穿刺位置选择宜远离原切口瘢痕,分离粘连时注意输尿管位置的改变,可以有效地降低腹腔镜转开腹手术率及手术损伤的机会。
Objective To investigate the characteristics of ovarian masses after total hysterectomy for benign diseases or precancerous lesions and to summarize the skills of laparoscopic surgery. Methods The clinical data of 132 patients who undergone surgical treatment of pelvic mass after hysterectomy in the Fourth Hospital of Hebei Medical University from August 2005 to August 2013 were collected. The clinical data of patients with benign and malignant ovarian masses, Surgery and initial surgery interval analysis. Results Of the 132 patients, 94 cases of benign ovarian tumors were found, accounting for 71.21%. Of them, ovarian cyst and ovarian chocolate cyst were more common. Malignant tumors were found in 38 cases (28.79%), most of which were ovarian serous cystadenocarcinomas. Ovarian tumors after hysterectomy good hair age> 45 ~ 55 years old. After hysterectomy benign ovarian tumor and malignant tumors occurred more than 10 years after surgery. Laparoscopic surgery, should pay attention to the choice of puncture holes, adhesion and ureter decomposition of the location change. Conclusions Ovarian masses after total hysterectomy are benign and can be selected by laparoscopy. Cesarean section operation should choose the location of the needle away from the original scar, separation of adhesions pay attention to changes in ureteral position, can effectively reduce the laparoscopic conversion rate of laparotomy and surgical injury opportunities.