306例腹腔镜检查下阴式子宫全切术临床分析

目的探讨腹腔镜检查在阴式子宫全切术（TVH）中的优点及应用价值。方法回顾性分析山西医科大学第二医院2005年4月～2009年2月间行腹腔镜检查下TVH手术的306例的临床资料,分析手术时间、出血量、术后住院日、术中术后并发症和术中临时处理等临床效果以及手术适应症,尤其是子宫大小、盆腔粘连和附件情况。结果腹腔镜检查阴式子宫全切术术中发现子宫大于3月患者占28.1%,腹腔粘连患者占29.4%;腹腔镜下对全部粘连患者进行粘连松解,分别为37.2%和4.2%患者进行附件手术和子宫内膜异位灶电灼术,术中2例腹腔镜检查后评估不适行阴式手术改开腹手术;所有临床效果好,患者均痊愈出院。结论腹腔镜检查扩大了TVH的适应症及提高了其安全性,对TVH的广泛开展起到了很大的促进作用。

The clinical analysis of transvaginal hysterectomy with intraoperative laparoscopy for 306 cases

Objective To evaluate the advantages of intraoperative laparoscopy used in transvaginal hysterectomy （TVH）.Methods Retrospectively analysis the clinical data of 306 patients who received TVH with intraoperative laparoscopy between April 2005 and February 2009 in the Department of Gynecology of the Second Hospital of Shanxi Medical University.Analyze the clinical effects by operative time,blood loss,postoperative hospital stay,intraoperative and post-surgery complications and surgical indications,particularly the size of the uterus, pelvic adhesion and adnexa cases. Results The proportion of the uterus size greater than 3 months gestational size is 28.1%, proportion of pelvic adhesions is 29.4%; all adhesion patients were treatment with adhesiolysis by laparoscope, 37. 2% and 4.2% patients were treated with adnexa surgeries and electrocautery respectively,2 cases were ransitted to abdominal hysterectomy after laparoscopy in that the situation were not suitable for vaginal hysterectomy; the clinical effects were good, all patients were discharged with good conditions. Conclusion Laparoscopy could expand the indications of TVH and enhance its security, also could promotes the utilization of TVH more broaderly.