腹腔镜辅助下阴式子宫切除术切除巨大子宫肌瘤58例体会

目的 探讨巨大子宫肌瘤行腹腔镜手术的可行性.方法 2005年1月～2007年12月用Liga Sure行腹腔镜辅助下阴式子宫切除术(LAVH)142例,其中巨大子宫肌瘤58例,其余的84例作为对照组,比较两组患者手术时间、术中出血量、排气时间、术后住院天数等指标.结果 142例患者手术全部在腹腔镜下进行,无中转开腹,其中手术时间差异有显著性(P<0.05).其他指标差异均无显著性(P>0.05).结论 巨大子宫肌瘤行腹腔镜辅助下阴式子宫切除术是安全可行的,只要不断提高医生的自身技术水平,具备良好的器械,完全可以在腹腔镜下完成.     

Minilaparotomy-Assisted LAVH for a Very Large Fibroid

We present the case report of a minilaparotomy-assisted LAVH carried out for the largest uterine myoma ever reported, with size equivalent to a full-term gestation.     

导尿管留置时间对腹腔镜辅助阴式子宫切除术患者排尿结果的影响

目的探讨腹腔镜辅助阴式子宫切除术（LAVH）后不同导尿管拔出时间对患者排尿结果的影响,为确定最佳拔管时间提供依据。方法将139例符合纳入标准的患者随机分为非留置导尿组47例,留置1d组46例,留置2d组46例,分别于相应的时间拔出尿管。对3组患者发生术后尿潴留（PUR）、尿路感染（UTI）和重置导尿管的情况进行观察比较。结果3组患者的尿潴留和尿路感染发生率有显著差异,但重置导管率无显著差异。结论LAVH术后应尽早拔出导尿管,以减少尿路感染的发生率。     

Outcomes and complications of laparoscopically assisted vaginal hysterectomy.

OBJECTIVE: To report whether operative time, intraoperative complications, and rate of conversion to laparotomy decreased after physicians had acquired an additional 4years experience with laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: Group 1 (n=462) included the women who underwent LAVH from May 1, 1994 to December 31, 1997, and group 2 (n=583) included those who underwent LAVH from January 1, 1998 to December 31, 2001. RESULTS: The mean duration of surgery in groups 1 and 2 was 146 and 114 min, respectively, and the difference was significant (P<0.0001). The overall complication rate in the last 4years of the study was 7.1%, which was significantly lower than the 13.4% calculated for the first 4years (P=0.001). CONCLUSION: Operative time as well as rates of surgical complications and conversion to laparotomy decreased with increased surgeon experience at performing LAVH.     

A new technique for dissecting the bladder laparoscopically

To evaluate a new technique designed to facilitate bladder dissection during laparoscopic-assisted vaginal hysterectomy (LAVH). Minimal access surgery unit, James Cook University Hospital. A retrospective review of 130 LAVHs in which the bladder was dissected laparoscopically. A metal catheter was used to facilitate identification of the bladder edge, and a sponge forceps was inserted vaginally to mark the site for anterior colpotomy. Then monopolar scissors were used to open the vagina. The hysterectomy was then completed vaginally. In this series there were 14 (10.8%) recorded complications with two (1.5%) major complications (95% confidence interval 0.2–5.5%). There was one bladder trauma (0.7%; 95% confidence interval 0.02–4.2%), which was recognised immediately and repaired with laparoscopic intracorporeal knots. One patient required additional vault sutures 6 h postsurgery because of vaginal bleeding. The mean operating time was 98.7 min, and the recorded mean hospital stay was 2.7 days, with a range of 2–5 days. The recorded estimated intraoperative blood loss ranged from 75 to 300 ml, with a mean loss of 195 ml, and four patients required blood transfusion. Dissection of the bladder laparoscopically adds 5–10 min to the operative time but significantly facilitates identifying the appropriate plane. It is an easy technique to learn and teach. It is associated with minimal complications, with no increased incidence of bladder injury or dysfunction.     

改良子宫腹腔镜辅助阴式子宫切除术的临床应用

目的比较常规腹腔镜辅助阴式子宫切除术（LAVH）与改良LAVH在大子宫切除中的临床效果。方法收集我院2003年12月～2007年12月接受以上不同术式大子宫切除术318病例的临床资料，其中常规LAVH 122例（常规组），改良LAVH 196例（改良组），比较两组的手术时间、术中出血量、体温恢复时间、术中及术后并发症和远期并发症等。结果改良组与常规组相比，手术时间明显缩短（P〈0．001），出血量明显减少（P〈0．001），但体温恢复时间接近（P〉0．05）。常规组术中发生膀胱损伤2例，转开腹行膀胱修补、阴道残端脓肿1例，改良组全部均在镜下完成，无中转开腹。近期随访，常规组发生阴道前壁脱垂2例，阴道后壁轻度脱垂1例，改良组无严重并发症发生。结论改良LAVH在大子宫切除方面优于常规LAVH。     

PK刀在腹腔镜辅助阴式子宫切除术中的应用

目的探讨等离子PK刀在LAVH中的应用价值。方法回顾性分析我院妇科2004年5月～2007年4月,住院行LAVH的248例患者的临床资料。比较PK刀与双极电凝钳在LAVH中的手术时间、术中腹腔出血量、术中术后并发症和术后患者恢复情况。结果与双极相比,PK刀明显减少术中出血量、显著缩短手术时间。结论PK刀在LAVH中具有一定的优势,改变了双极凭经验掌握电凝程度的不足,避免了组织凝固不均、组织凝固过度炭化和凝固不全出血等缺点,并具有止血效果佳、热辐射损伤范围小、操纵简单等优点,值得推广使用。     

22例腹腔镜辅助阴式子宫切除术的临床效果分析

目的：探讨腹腔镜辅助下阴式子宫切除术（LAVH）的临床效果。方法：2006～2007年6月子宫切除病例52例,其中22例LAVH作为观察组,30例腹式子宫切除术（TAn）作为对照组,将患者手术时间、术中出血量和术后情况进行分析比较。结果：LAVH较TAH手术时间明显延长,术中出血较TAH明显减少,术后下床活动时间、术后病率、肛门排气时间、术后住院日明显低于TAH组（（P〈0．05））。结论：LAVH具有创伤小、肠道干扰少、恢复快、住院时间短等优点,是有效的子宫切除方式。