【摘要】 目的探讨腹腔镜下游离阻断子宫动脉的全子宫切除术的临床效果。方法2004年1月~2006年6月,对68例子宫良性病变在腹腔镜下游离出子宫动脉后钛夹夹闭,阻断子宫动脉行全子宫切除术。结果68例手术均获成功,无中转开腹,无手术并发症发生。其中1例游离双侧子宫动脉失败,双极电凝后完成手术(有2次剖宫产手术史)。术中同时行盆腔粘连分离术18例,单侧或双侧附件切除术14例,卵巢囊肿剔除术8例,阑尾切除术1例,胆囊切除术1例。手术时间90~185 min,(112.6±27.5)min,每侧子宫动脉的分离时间3~15 min,(5.2±3.4)min,术中出血量50~150 ml,(86.5±39.6)ml,术后肠功能恢复时间18~48 h,(27.3±4.8)h,术后病率4.4%(3/68),术后住院时间4~7 d,(5.1±1.8)d。术后随访2~6个月,(3.5±1.6)月,3例术后1~2个月时阴道点滴出血,经抗感染、止血等治疗5~7天治愈。结论腹腔镜下游离阻断子宫动脉的全子宫切除术安全、可行、有效、并发症少,值得临床推广应用。更多还原

【Abstract】 Objective To investigate the clinical efficacy of total laparoscopic hysterectomy(TLH) with separating and blocking uterine arteries.Methods From January 2004 to June 2006,68 cases of uterine benign diseases underwent TLH by blocking uterine arteries after separating and clipping uterine arteries with Titanic clip.Results All operations were performed successfully without conversion to open surgery and complications.1 patient,who had twice gastrohysterectomy histories,underwent bipolar coagulating uterine arteries as to the failure of separating bilateral uterine arteries.Pelvic adhesion release was performed in 18 cases,unilateral or bilateral adnexectomy in 14 cases,oophorocystectomy in 8 cases,appendectomy in 1 case,and cholecystectomy in 1 case simultaneously.The operation time was 90-185 min,(112.6±27.5)min.The time of separating uterine artery in one side was 3-15 min,(5.2±3.4)min.The intraoperative blood loss was 50-150 ml,(86.5±39.6)ml.The time to first bowel movement was 18-48 h,(27.3±4.8)h.The rate of postoperative pyrexia was 4.4%(3/68),and the hospital stay was 4-7 d,(5.1±1.8) d.A follow-up period of 2-6 months,(3.5±1.6) months,showed 3 cases of vaginal dropping hemorrhage 1-2 months after operation,which was cured with the use of antibiotics and hemostatics for 5-7 d.Conclusions TLH with separating and blocking uterine arteries is a safe,effective and feasible procedure with less complication,so it is worthy of being recommended.更多还原