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目的:探讨腹腔镜下巨大子宫切除术的手术技巧及可行性。方法:回顾性分析60例子宫大于12孕周患者,行腹腔镜子宫切除手术的临床资料,其中12例腹腔镜下全子宫切除术(Total laparoscopic hysterectomy,TLH),32例腹腔镜次全子宫切除术(laparoscopic supracervical hysterectomy,LSH),10例腹腔镜辅助阴式全子宫切除术(lapamscopic-assisted vaginal hys-terectomy,LAVH)和6例腹腔镜下筋膜内全子宫切除术(laparoscopic intrafacial supercervical hysterectomy,LISH)。手术中置镜位置取在肚脐和剑突之间。手术关键步骤是对子宫血管的有效阻断,其中TLH和LAVH在阻断子宫血管后先旋切掉大部分宫体。结果:60例患者全部在腹腔镜下完成手术,无1例中转开腹。2例术后发现皮下气肿,1例阴道残端延期愈合,余无其他并发症发生。手术时间(108±42.0)min,术中出血量(125±25)ml,术后住院时间(5.5±0.5)天。60例均随访3个月,未出现术后近期或远期严重并发症。结论:选择适宜手术操作的置镜孔,熟练掌握手术操作技巧,处理好附件及子宫血管,腹腔镜下如孕3月以上巨大子宫切除术亦是安全、可行的,不增加手术风险及并发症。
Objective: To explore the surgical technique and feasibility of laparoscopic radical hysterectomy. Methods: The clinical data of 60 cases of uterus more than 12 gestational weeks were analyzed retrospectively. Total laparoscopic hysterectomy (TLH) was performed in 12 cases and laparoscopic subtotal hysterectomy Laparoscopic-assisted hysterectomy (LAVH), laparoscopic supracervical hysterectomy (LSH), laparoscopic-assisted vaginal hysterectomy (LAVH) and laparoscopic intrafacial supercervical hysterectomy LISH). Place the mirror in the operation taken between the navel and xiphoid. The key step of surgery is the effective blocking of the uterine blood vessels, in which TLH and LAVH first circumcise most of the uterine bodies after blocking the uterine blood vessels. Results: All the 60 patients underwent laparoscopic surgery, none of whom underwent laparotomy. Subcutaneous emphysema was found in 2 cases, delayed healing of vaginal stump in 1 case, and no other complications occurred. The operative time (108 ± 42.0) min, intraoperative blood loss (125 ± 25) ml, postoperative hospital stay (5.5 ± 0.5) days. 60 cases were followed up for 3 months, no serious complications occurred in the near future or long term. Conclusion: It is safe and practicable to choose the appropriate lens for operation, master the skill of operation, handle the accessory and uterine blood vessels, and laparoscopic surgery such as hypertrophy of hysterectomy in March and above is safe and feasible without increasing the operation risk and complication .