腹腔镜联合小切口全子宫切除术治疗超过1kg的巨大肌瘤子宫——个人经验

发布时间：2018-06-05 11:47

本文选题：腹腔镜 + 小切口手术　；参考：《中国微创外科杂志》2015年01期

【摘要】：目的介绍腹腔镜联合小切口全子宫切除术(laparoscopy and minilaparotomy hysterectomy,LMH)治疗超过1 kg的巨大肌瘤子宫的手术技巧及结果。方法 2011年5月~2013年12月,10例巨大肌瘤子宫(超过1 kg)患者接受LMH,其中6例联合附件切除术。本文回顾性分析其病例特点、手术资料和结果。先使用腹腔镜探查评估卵巢、输卵管、粘连情况,以及子宫肌瘤的大小和位置。做6 cm的小切口。在腹腔镜照明和监视下,经小切口电凝卵巢或子宫血管。同样圆韧带、输卵管或卵巢骨盆漏斗韧带也可以使用传统的开放手术器械和技术电凝和分离。对巨大肌瘤子宫,在进行标准的子宫切除前通常需要先行肌瘤切除以缩小子宫体积,或先行子宫次全切除以将巨大肌瘤从宫颈分离。巨大子宫可以粉碎后经小切口取出。结果所有手术成功实施,无术中或术后并发症。平均手术时间2 h。所有患者术后恢复良好,出院时间1.5~3 d。结论对于超过1 kg的巨大肌瘤子宫,腹腔镜联合小切口全子宫切除术可以代替开腹全子宫切除术,是腹腔镜全子宫切除术外又一种安全、可行的微创手术。
[Abstract]:Objective to introduce the surgical techniques and results of laparoscopic and minilaparotomy hysterectomy combined with small incision hysterectomy for the treatment of giant leiomyoma of more than 1 kg. Methods from May 2011 to December 2013, 10 patients with giant leiomyoma (more than 1 kg) were treated with LMH, 6 of which were treated with adnexectomy. This article retrospectively analyzed the case characteristics, surgical data and results. Laparoscopy was used to evaluate ovarian, fallopian tubes, adhesions, and the size and location of uterine leiomyomas. Make a small incision of 6 cm. Ovarian or uterine blood vessels are electrocoagulated through small incision under laparoscopic illumination and surveillance. The same round ligaments, tubal or ovarian pelvic funnel ligaments can also be electrocoagulated and separated using traditional open surgical instruments and techniques. For giant leiomyomas, myomectomy is usually required before standard hysterectomy to reduce the size of the uterus, or subtotal hysterectomy is required to separate giant leiomyomas from the cervix. The giant uterus can be crushed and removed by a small incision. Results all operations were performed successfully without intraoperative or postoperative complications. The average operation time was 2 hours. All the patients recovered well after operation, and the discharge time was 1.5 ~ 3 days. Conclusion Laparoscopic combined with small incision hysterectomy is a safe and feasible minimally invasive operation for giant leiomyomatous uterus with more than 1 kg, which can replace open hysterectomy.
【作者单位】：香港圣保罗医院妇产科;
【分类号】：R737.33

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