腹腔镜治疗妇科肿瘤适应证的初步探讨

目的 :探讨腹腔镜手术治疗妇科肿瘤的适应证。方法 :腹腔镜下行附件切除或囊肿剥除 ,子宫切除 ,妇科恶性肿瘤盆腔淋巴切除、卵巢动静脉高位结扎或大网膜切除。并以相应开腹手术作对照。结果 :腹腔镜手术进腹与缝合腹壁时间短、恒定 ,而开腹手术却受手术的大小和患者肥胖程度的影响。腹腔镜对小于 10cm的卵巢囊性肿瘤或子宫小于3月妊娠大小的子宫肿瘤患者 ,手术时间及过程与开腹手术比较没有显著区别。但对于更大囊性肿瘤或子宫肿瘤 ,腹腔镜手术难度加大 ,时间显著延长 ,开腹手术优于腔镜手术。合并盆腔脏器粘连者 ,两者处理过程相似。腹腔镜下处理妇科恶性肿瘤需较高的操作技巧和相应的手术器械 ,手术效果可与开腹手术相类似。结论 :腹腔镜手术适应于较小的卵巢囊性肿瘤或子宫肿瘤 ,对于子宫内膜癌等恶性肿瘤需处理淋巴结或探查上腹部者 ,腹腔镜手术效果和预后亦可与开腹手术相类似。因腹壁创伤小、腹腔干扰小 ,术后恢复明显优于开腹手术。

The Study of Indications to Gynecologic Tumor Treatment by Laparoscopy

Objective: To study the indication in treatment of gynecologic tumor by Laparoscopy. Methods: 73 cases of appendage resection, 30 cases of hysterectomy,10 cases of corpus uteri carcinoma or ovarian malignant tumor cases with pelvic lymphadenectomy and high point cutting of ovarian blood vessels and epiploectomy, and 5 cases of malignant ovarian tumors with Staging III were operated by laparoscopy. The same kinds of surgery by laparotomy were chosen as controls. Results: The operative time into abdomen wall by laparoscopy was short and steady, but it's variable and long in laparotomy according to different kind of operation and/or how fat the patient was. The operative time and process by laparoscopy were similar to those of laparotomy when the diameter of cysts was less than 10cm or the volume of uterus smaller than 3 month of pregnant. The degree of difficulty and operative time operated by laparoscopy increased when tumor size beyond above range. No difference had been found between two surgical methods in the process of pelvic adhesion. Although a high level of technique skills and instruments were needed in laparoscopic surgery, the result of operation was similar to laparostomy in the treatment of malignant tumors. Less pain, soon recovery, and no incision problem after operation were the predominance of laparoscopy. Conclusions: Laparoscopic surgery is adaptable to small gynecologic tumor and has a similar effect to laparotomy. It is superior to laparotomy with less injury and recovery shortly after operation.