腹腔镜子宫切除术中预防输尿管损伤方法探讨

目的:探讨腹腔镜子宫切除术中避免输尿管损伤的方法。比较3种方法处理子宫动脉的手术效果。方法:将57例患子宫良性疾病腹腔镜子宫切除术者分3组:组1:常规组。组2:膀胱镜输尿管置管组。组3:游离输尿管组。比较用3种不同方法处理子宫血管的效果及其术后情况。结果:均顺利完成手术,无术中术后并发症,手术时间组3少于组1和组2,P值=0.005,差异有显著性;术时出血量3组无显著性差异,3组术后排尿时间差异无显著性P=0.978,组2术后血尿出现率及持续时间高于1、3组,差异有统计学意义,P<0.001,术后病率亦较高,P<0.05,差异有显著性。结论:采用游离盆腔段输尿管和子宫血管的方法可有效地避免输尿管损伤,并且不增加手术时间及术中出血量。术后亦能如期恢复。但需要术者对盆腔输尿管及血管解剖熟悉并且有熟练的腹腔镜手术技巧。

Prevent ureter injury in laparoscopic hysterectomy

Objective:Three kinds of methods were compared to discuss how to avoid ureter injury during laparoscopic hysterectomy.Methods:57 patients who suffered from uterine benign disease and submitted to perform laparoscopic hysterectomy were divided into 3 groups randomly, the first group was for routine procedure to coagulate uterine vessels, the second group was for ureter catheter insertion, and the third group was for ureter dissection and uterine artery ligation.Postoperative effects of the three different techniques were compared.Results:All the operations were accomplished successfully.The mean operation time for the third group was less than that of the first group and the second group,P=0.005.There was no difference for the mean blood loss and postoperative urination time,P= 0.978.The mean postoperative hematuria frequency and duration of the second group was higher than that of the first group and the third group,P< 0.001.The postoperative morbidity of the second group was also higher than that of the first group and the third group, P<0.05.Conclusion:On the contrary, the method of ureter dissection and uterine vessels ligation can avoid the complication effectively. It won't extend the operation time or cause more blood loss, and the recovery of patients is fast. But the surgeon should be proficient in laparoscopy surgeon and know the ureter and uterine vessels dissection very well.