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目的:探讨缝扎法处理子宫血管在腹腔镜子宫切除术中的临床应用价值。方法:2009年3月～2012年8月在腹腔镜下子宫切除术中采用缝扎法和双极电凝法处理血管,比较两种方法的手术时间、手术出血量、术后肛门排气时间、术后体温、并发症发生及中转开腹情况。结果:缝扎组与电凝组的手术时间比较无明显差异,但手术出血量、术后肛门排气时间、患者腹胀发生率及术后体温恢复正常时间,两组比较均有统计学差异(P<0.05)。缝扎组中1例子宫腺肌症患者行腹腔镜子宫全切患者因子宫与肠管致密粘连中转开腹,其余均在腹腔镜下完成,术后无泌尿系统损伤,电凝组1例子宫肌瘤患者行腹腔镜全切患者术中因处理子宫血管时大量出血转开腹手术,其余均在腹腔镜下完成。1例子宫肌瘤行腹腔镜次切患者术后5天阴道流液,经输尿管插管失败行开腹输尿管部分切除膀胱种植后痊愈。结论:缝扎法处理子宫血管减少双极电凝时间,明显减少了热损伤致输尿管损伤发生率,减少术中出血,使手术安全性大大提高,且不受器械条件限制,值得推广。
Objective: To investigate the clinical value of suture treatment of uterine vessels in laparoscopic hysterectomy. Methods: From March 2009 to August 2012, suture and bipolar electrocoagulation were used in laparoscopic hysterectomy to treat the vessels. The operation time, operative bleeding volume, postoperative anal exhaust time , Postoperative body temperature, complications and transit laparotomy. Results: There was no significant difference in operation time between suture group and electrocoagulation group, but there was significant difference between the two groups (P> 0.05), but the amount of operation bleeding, postoperative anal exhaust time, incidence of abdominal distension and postoperative body temperature recovery time were statistically significant P <0.05). Suture group in 1 case of adenomyosis patients underwent laparoscopic hysterectomy due to uterine and intestinal tight adhesions transit laparotomy, the rest were laparoscopic surgery, no urinary tract injury, electrocoagulation group, 1 case of uterine muscle Tumor patients underwent laparoscopic resection of patients due to treatment of uterine blood vessels to a large number of bleeding to open surgery, the rest are done in laparoscopy. One case of uterine fibroids underwent laparoscopic resection of patients with vaginal fluid 5 days after surgery, failed ureteral intubation after partial removal of the ureter after bladder resection cured. Conclusion: Suture treatment of uterine vessels reduces bipolar coagulation time, significantly reduce the incidence of ureteral injury caused by thermal injury and reduce intraoperative bleeding, the safety of surgery greatly improved, and is not subject to device constraints, it is worth promoting.