非脱垂子宫阴式全子宫切除术同时附件切除的可行性分析  

Feasibility of Adnexectomy during Transvaginal Hysterectomy (TVH) for Non-prolapsed Uterus

作　　者：王伟 胡海燕 程明青 郑敏 刘春华 

机构地区：[1]山东省日照市东港区人民医院妇科,日照276800

出　　处：《中国微创外科杂志》2011年第10期893-895,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨阴式全子宫切除术(transvaginal hysterectomy,TVH)联合双附件切除术的可行性。方法 2007年1月～2010年1月施行119例TVH联合双附件切除术。经阴道切除子宫后,先不剪断附件侧的输卵管、卵巢固有韧带、圆韧带断端结扎线,下牵附件侧结扎线,暴露、钳夹、切断、结扎输卵管系膜,切除输卵管;再钳夹、切断、缝扎卵巢悬韧带、卵巢系膜,切除卵巢。结果 117例成功施行TVH联合双附件切除术,2例行TVH联合单侧附件切除术(单侧卵巢未能切除),无膀胱、直肠损伤。手术时间(69.5±20.7)min,术中出血量(83.3±20.3)ml,肛门排气时间(19.0±3.5)h,术后病率10.9%(13/119)。118例随访2～24个月,平均4.3月,阴道断端愈合良好,盆腔无异常包块,无并发症发生。结论在一定适应证下,采用切除附件时先行输卵管切除,再切除卵巢的方法,TVH联合双附件切除术是安全、可行的。Objective To investigate the feasibility of bilateral adnexetomy during transvaginal hysterectomy（TVH）.Methods A retrospective analysis was made on clinical data of 119 patients who received adnexectomy during TVH from January 2007 to January 2010 in our hospital.After the uterus was removed through transvaginal approach,keeping the ligatures of the uterine tube,ovarian proper ligament,and round ligament stump in the adnexal side first,we dragged down the adnexal side ligature,exposed,vised,cut off,and ligated the mesosalpinx,and then removed the uterine tube;afterwards we vised,cut off,and transfixed the infundibulopelvic ligament and mesovarium,and removed the ovary.Results Totally 117 patients received TVH plus bilateral adnexetomy and 2 underwent TVH plus unilateral adnexectomy（only one ovary was resected） without bladder or rectum injuries.In TVH＋bilateral adnexectomy group,the operation time,intraoperative blood loss,gastrointestinal recovery time,and postoperative morbidity were（69.5±20.7） min,（83.3±20.3） ml,（19.0 ±3.5） h,and 10.9% respectively.118 patients were followed up for 2 to 24 months postoperatively（mean,4.3 months）,which showed that the vaginal stump healed well without pelvic mass or complication occurred. Conclusion In certain operative indications,TVH and bilateral adnexectomy can be safe and feasible by removing the uterine tube before resecting the ovary.

关 键 词：阴式全子宫切除术 附件切除术 

分 类 号：R713.4[医药卫生—妇产科学]