困难性腹腔镜全子宫切除73例

目的探讨腹腔镜下困难全子宫切除术的可行性和手术技巧。方法2008年1月-2011年1月行腹腔镜困难子宫切除手术73例，其中41例子宫〉12孕周，32例盆腔重度粘连。提升第一穿刺孔位置到脐上方1—2cm，分离盆腔粘连，上举子宫，打开盆侧壁，找准输尿管走行，输尿管与子宫动脉交叉处分离出子宫动脉，电凝子宫动脉，切除部分宫体后即可按常规步骤顺利切除子宫。结果73例全部在腹腔镜下完成全子宫切除，无中转开腹。手术时间75—118min，（80．8±30．5）min。术中出血量30-130ml，平均80ml。住院时间4～6d，平均5d。73例随访3个月：2例术后10d阴道残端愈合差，有少许出血，经过阴道上药后治愈；其余71例术后均恢复良好。结论腹腔镜下困难全子宫切除术是可行的，熟练掌握上举子宫，处理子宫动脉，缩小子宫体积，以及分离盆腔粘连的手术技巧，腹腔镜下困难全子宫切除并不会增加手术危险性和手术并发症。

Complicated Total Laparoscopic Hysterectomy: Report of 73 Cases

Objective To explore the feasibility and operation skills of complicated total laparoscopic hysterectomy. Methods From January 2008 to January 2011, we performed complicated total laparoscopic hysterectomy On 73 patients, including 41 patients with the uterus larger than 12-week gestation, and 32 patients with severe pelvic adhesion. With the first puncture site located at 1- to 2-cm above the umbilicus, we separated the pelvic adhesion, lifted the uterus, and opened the lateral wall of the basin to identify the ureter; and then we isolated the uterine arteries at the intersection of the ureter and the uterine artery to eleetrocoagulate the uterine artery and removed part of the palace. Afterwards, standard procedure for hysterectomy was carried out. Results The procedure was completed in all the 73 cases without conversion to open surgery. The mean operation time was （80.8 ± 30.5） rain （ranged from 75 to 118 rain） , and the intraoperative blood loss was 80 ml （30 -130 ml）. The mean hospital stay of the patients was 5 days （4 - 6 days）. Follow-up was achieved in all the patients for 3 months, during which all the patients recovered well, except for two, who showed mild virginal bleeding in lO days after the surgery because of poor healing of the virginal stump. These two patients were cured afterwards by conservative therapy. Conclusions Total laparoscopic hysterectomy is feasible for complicated cases. The key steps of the operation include lifting the uterus, managing the uterine arteries, reducing the uterine volume, and separating pelvic adhesion. The procedure does not increase the risk of the surgery or the rate of complications.