子宫肌瘤697例的微创手术治疗  

Minimally invasive surgery for 697 cases with uterine myoma

作　　者：陈捷[1] 宋一一[1] 郑惠英[1] 林元[1] 陈丽[1] 

机构地区：[1]福建省妇幼保健院,福建福州350001

出　　处：《腹腔镜外科杂志》2004年第4期218-220,共3页Journal of Laparoscopic Surgery

摘　　要：目的:评价子宫肌瘤微创手术的价值和手术适应证。方法:宫腔镜下经宫颈行子宫肌瘤切除术(TCRM)115例,完全腹腔镜下行全子宫切除术(TLH)5例,腹腔镜行全子宫切除术(LH)58例,腹腔镜鞘内子宫切除术(CISH)153例,腹腔镜次全子宫切除术(LSH)8例,腹腔镜辅助阴式子宫切除术(LAVH)36例,腹腔镜子宫肌瘤剜除术(LM)156例,阴式全子宫切除术(TVH)166例。结果:子宫肌瘤697例行微创手术治疗均获成功。结论:TCRM主要适于子宫粘膜下肌瘤及部分内突型壁间肌瘤。LM术主要适于保留子宫的肌瘤。CISH术适于年轻患者。但宫颈极度肥大,宫颈重度糜烂,CIN者,应行LAVH、LH、TLH术或TVH。TVH适于宫颈肥大、宫颈重度糜烂、CIN者,尤其是合并子宫脱垂、阴道壁膨出、张力性尿失禁、子宫腺肌病患者。对盆腔粘连尤其需要切除附件者以行LAVH术为宜。Objective:To assess the application and value of minimally invasive myomectomy for the treatment of uterine myoma. Methods: 115 cases of uterine myoma were performed by transcervical resection of myoma(TCRM) under hysteroscope, 5 cases were performed by total laparoscopic hysterectomy(TLH) ,58 cases were performed by laparoscopic hysterectomy(LH)), 153 cases were performed by classical intrafascial supracervical hysterectomy(CISH), 8 cases were performed by laparoscopic supracervical hysterectomy(LSH) ,36 cases were performed by laparoscopiclly assisted vaginal hysterectomy(LAVH) , 156 cases were performed by laparoscopic hystero-myomectomy(LM)and 166 cases were performed by total vaginal hysterectomy(TVH) .Results: All were successfully operated.Conclusions:TCRM is mainly applicable to submucous myoma and to some intramural myoma. LM is mainly applicable to cases of myoma removed while keeping the uterus. CISH is especially ideal for young patients. But for patients with Ⅲ erosion of cervix and CIN patients, LAVH,LH, TLH or TVH is more effective. TVH is applicable to patients with Ⅲ erosion of cervix and CIN, especially to those with bysteroptosis, stress urinary incontinence and adenomyosis. LAVH is applicable to patients with pelvic adhesion.

关 键 词：子宫肌瘤 微创手术 治疗 宫腔镜 腹腔镜 子宫切除术 

分 类 号：R737.33[医药卫生—肿瘤]