腹腔镜全子宫切除术的手术技巧改进及其临床价值  

The clinical value of surgical skill improvement of total laparoscopic hysterectomy

作　　者：苏悦[1] 顾扬[1] 高玲玲[1] SU Yue;GU Yang;GAO Ling-ling(Department of Gynecology,Northern Jiangsu People's Hospital,Yangzhou 225001,China)

机构地区：[1]江苏省苏北人民医院

出　　处：《腹腔镜外科杂志》2019年第7期543-545,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜全子宫切除术中采用改良方法处理子宫血管及宫旁组织的临床效果及价值。方法:收集2016年1月1日至2017年10月1日为585例患者行腹腔镜全子宫切除术的临床资料。其中259例采用改良法行全子宫切除术(改良组),326例采用传统手术方法(对照组)。改良组处理子宫血管的步骤进行了改良:电凝两侧子宫血管,先不切断;沿举宫杯切开部分阴道前壁;直视举宫杯,处理子宫血管、宫旁组织。观察两组手术时间、术中出血量、中转率、术后肛门排气时间、术后住院时间。结果:改良组与对照组术中出血量[(15.8±8.2)mL vs.(30.7±12.1)mL,t=16.96,P<0.05]差异有统计学意义,手术时间、中转开腹率、肛门排气时间、术后住院时间差异无统计学意义(P>0.05)。结论:腹腔镜全子宫切除术术中采用改良法处理子宫血管、宫旁组织,减少了术中出血量及止血步骤,增加了手术安全性。Objective:To discuss the effect and clinical value of the improved surgical method which is used to deal with the u terine vessels and parametrial tissue in total laparoscopic hysterectomy.Methods:From Jan.1 2016 to Oct.1 2017 the clinical data of 585 patients who underwent total laparoscopic hysterectomy were collected.259 patients who underwent improved total laparoscopic hys terectomy were included in the improved group.326 patients who were treated with classic surgery were included in control group.The improved steps of treating the uterine blood vessels were as follows:the uterine vessels on both sides of the uterus were electrocoagulated but not cut off first The anterior wall of the vagina was cut along the uterine cup and the uterine vessels and parametrial tissue were re treated under the direct vision of the uterine cup.Operation time intraoperative blood loss the rate of conversion to laparotomy postoper ative anal exhaust time and postoperative hospital stay in the two groups were compared.Results:The blood loss of the improved group and the control group was [(15.8±8.2)mL vs.(30.7±12.1)mL t=16.96 P<0.05].There was no significant difference in the operation time rate of conversion to laparotomy postoperative anal exhaust time or postoperative hospital stay between the two groups (P>0.05). Conclusions:In the total laparoscopic hysterectomy the modified method of dealing with the uterine blood vessels and parametrial tissue can reduce the intraoperative blood loss and the steps of hemostasis and increase the safety of the operation.

关 键 词：子宫切除术 腹腔镜检查 子宫血管 失血 手术 

分 类 号：R713.42[医药卫生—妇产科学]