论文部分内容阅读
目的探讨腹腔镜下进行困难性子宫肌瘤剔除术的可行性。方法收集我院2009年1月至2012年2月巨大、多发、特殊部位的子宫肌瘤患者120例。在腹腔镜下,术中采用腹腔镜超声监护、输尿管插管,必要时联合宫腔镜行子宫肌瘤剔除术,观察手术并发症、手术时间、术中出血量及术后恢复情况。结果在全部120例患者中,多发子宫肌瘤肌瘤数目>5个者59例,单发子宫肌瘤直径>8cm者43例(其中子宫肌壁间肌瘤29例,子宫浆膜下肌瘤14例),子宫阔韧带肌瘤9例,子宫颈肌瘤9例。剔除子宫肌瘤最多达15个,子宫肌瘤直径≥10cm者11例,其中直径最大的达12cm(为阔韧带肌瘤,重1800g)。患者手术均在腹腔镜下顺利完成,无一例中转开腹。平均手术时间(114±32)min,平均术中出血量(106±35)ml,术后平均住院时间5.1d。结论困难性子宫肌瘤剔除术可以在腹腔镜下完成,术中适当进行输尿管插管可降低输尿管损伤,术中超声的应用有助于彻底剔除肌瘤,降低术后复发率。联合宫腔镜手术可同时剔除粘膜下肌瘤,术后月经量增多症状明显缓解,合理应用辅助检查及熟练的手术技巧是手术成功的关键。
Objective To investigate the feasibility of laparoscopic difficult myomectomy. Methods A total of 120 patients with uterine fibroids were recruited in our hospital from January 2009 to February 2012, with huge, multiple and special parts. In laparoscopy, intraoperative laparoscopic ultrasound catheterization, ureteral intubation, uterine myomectomy combined with hysteroscopy when necessary, observe the complications, operation time, intraoperative blood loss and postoperative recovery. Results In all 120 patients, there were 59 cases with more than 5 myoma of multiple uterine fibroids and 43 cases with single uterine fibroids> 8 cm in diameter (including 29 cases of uterine fibroids, 14 cases), 9 cases of uterine broad ligament fibroids, 9 cases of cervical fibroids. Excluding uterine fibroids up to 15, uterine fibroids ≥ 10cm diameter 11 cases, of which the largest diameter up to 12cm (broad ligament fibroids, weighing 1800g). Patients underwent laparoscopic surgery were successfully completed, no case of conversion to laparotomy. The average operation time (114 ± 32) min, average blood loss (106 ± 35) ml, average postoperative hospital stay 5.1d. Conclusions Difficulty myomectomy can be done under laparoscopy. Appropriate ureteral intubation during operation can reduce ureteral injury. The application of intraoperative ultrasound can help to eliminate fibroids completely and reduce the recurrence rate. Combined hysteroscopic surgery can remove submucosal fibroids, postoperative menstrual flow increased symptoms were significantly alleviated, a reasonable application of auxiliary examination and skilled surgical skills is the key to the success of the operation.