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腹腔镜子宫切除术(laparoscopic hysterectomy,LH)自1989年引入临床,已经成为除了传统的经腹子宫切除术(abdominal hysterectomy,AH)的广泛的可以接受的另一种选择。一些随机对照试验表明LH与AH相比有它的优点,如恢复快、疼痛轻、住院时间短、近期生活质量高,而AH的优点在于手术时间短,若腹腔镜手术失败可作为一个后备的手术方案。通过对盆腔解剖有很好的了解而充分的术前评估,加之技术的成熟,作者(Felix Wong)用改良的小切口经腹子宫切除术(modified mini-laparotomy approach for abdominal hysterectomy,MAH)处理巨大子宫,体会在处理有潜在较复杂的病例中MAH可能更加适宜,如非常大的子宫平滑肌瘤或子宫重量超过500 g,尤其是当LH很难操作时或LH可能导致不适当的并发症时。在2006～2008年的回顾性分析中,MAH手术具有时间短、手术后止痛剂的使用少、术后感染率低的优点,尽管与LH相比,在做巨大子宫切除术时,MAH仍存在术中出血稍增加、手术后住院时间平均延长1.5 d的缺点。MAH伤口更小,疼痛更轻。本文显示MAH治疗增大的子宫的操作技术可以安全完成,不伴有任何器官损伤,手术时间更短。因此,在行巨大子宫切除术时,MAH可以作为一种备选的手术方法。
Laparoscopic hysterectomy (LH), introduced into the clinic since 1989, has become a widely accepted alternative to the traditional abdominal hysterectomy (AH). Some randomized controlled trials have shown LH to have advantages over AH, such as rapid recovery, light pain, short hospital stays, and high quality of life in the near future. The advantage of AH is that the procedure is short and laparoscopic surgery fails as a backup Surgery program. With a well-defined preoperative assessment of pelvic anatomy and the maturity of the technique, Felix Wong was treated with a modified mini-laparotomy approach for abdominal hysterectomy (MAH) Uterus, Experience MAH may be more appropriate in handling potentially more complicated cases such as very large uterine leiomyomas or uterine weights in excess of 500 g, especially when LH is difficult to manipulate or LH may cause inappropriate complications . In a retrospective analysis from 2006 to 2008, MAH had the advantage of short duration, less use of analgesics after surgery, and lower postoperative infection rate, although MAH was still present during a giant hysterectomy compared with LH Bleeding slightly increased after surgery, the average hospital stay after the extension of 1.5 d shortcomings. MAH wound smaller, less pain. This article shows that MAH treatment of the uterus increased the operation of technology can be safely completed, without any organ damage, shorter operation time. Therefore, MAH can be used as an alternative surgical method in the case of giant hysterectomy.