妇科腹腔镜手术878例经验总结  

Initial Experience of 878 Patients with Operative Gynecologic Laparoscopy

作　　者：张爱容[1] 王巧娣[1] 张莹静[1] 皮洁[1] 李翔[1] 王绍珍[1] 

机构地区：[1]湖北省荆州市中心医院妇产科

出　　处：《中华妇产科杂志》1997年第5期276-279,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的：总结妇科腹腔镜手术各种操作技术及其应用价值和注意事项。方法：回顾分析８７８例腹腔镜手术的经验，根据操作难度分为Ⅰ级、Ⅱ级、Ⅲ级，比较其手术时间、术后病率及并发症。Ⅰ级操作为内凝法，１２４例（Ｉ级组）；Ⅱ级操作为套扎、水分离法，６５３例（Ⅱ级组）；Ⅲ级操作为电切电凝、结扎缝合，１０１例（Ⅲ级组）。结果：８６６例手术全过程在镜下完成，无术时并发症；１２例因手术困难中转开腹手术。平均手术时间，Ⅰ级组４９分、Ⅱ级组７７分、Ⅲ级组１７１分。术后病率Ⅰ级组０．０％、Ⅱ级组４．８％、Ⅲ级组３３．３％。Ⅲ级组中有１例子宫切除术后发生感染、大出血。Ⅰ、Ⅱ级组无术后并发症、临床效果良好。结论：根据操作难度循序渐进地熟练操作技术，以进行相应手术，可获满意治疗效果并可望安全有效地开展妇科腹腔镜手术。Objective: To recommend the operative laparoscopic techniques for gynecology. Methods: Proper application of the technical skills was described on the basis of 878 operations performed laparoscopically. These skills were divided into three groups: level Ⅰ endocoagulation in 124 cases; level Ⅱ pretied ligature placement and aquadissection in 653 cases; level Ⅲ electrosection, electrocoagulation and knottying, suturing in 101 cases. Results: A total of 866 operations were completed laparoscopically without major intraoperative complications. Twelve cases were converted to laparotomy due to difficulties. The mean operating time for level Ⅰ, level Ⅱ and level Ⅲ group was 49 minutes, 77 minutes and 171 minutes respectively. The incidence of febrile mobidity for level Ⅰ, level Ⅱ and level Ⅲ group was 0.0%, 4.8% and 33.3% respectively. There was one case of postoperative haemorrhage associated with infection in the level Ⅲ group. However, no major post operative complications occurred in the level I￣Ⅱ group and the clinical outcome including the overall patients satisfaction was good. Conclusion: Mastery of operative laparoscopic techniques step by step along with the degree of surgical difficulty is madatory, and can deliver optimal clinical outcome hopefully. It will also help to expand the use of operative gynecologic laparoscopy in a safe and effective way.

关 键 词：妇科手术 腹腔镜 临床应用 

分 类 号：R713[医药卫生—妇产科学]