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目的 :探讨如何简化子宫全切术手术步骤 ,减少手术时间及术中出血量 ,降低术后病率 ,缩短患者术后住院时间。方法 :随机选择 1998年 8月至 1999年 3月在我院妇科住院施行传统腹式子宫全切术的患者 5 0例作为对照组 ,1999年 4～ 12月施行简化腹式子宫全切术的患者 5 0例作为研究组。手术采用下腹部皮皱处横切口 ,切开皮肤 ,钝性撕拉皮下组织、筋膜及腹膜 ;稍下推膀胱 ,环形切开宫颈筋膜并钝性加锐性向下分离 ,主、骶韧带随之下移不需处理 ,环形剪开阴道穹隆切除子宫 ;使用进口微乔可吸收合成线 ,皮下组织及筋膜合并连续缝合及皮内缝合皮肤 ,不缝合腹壁腹膜。两组处理子宫圆韧带、附件及血管方法相同。结果 :研究组比对照组手术时间减少约 75 .33min ,术中出血量减少约 130ml,术后患者住院天数缩短约 2 .1天 ,术后病率降低。结论 :简化腹式筋膜内子宫全切术可以推广应用于妇科良性病变及部分恶性病变需切除子宫者 ,尤其适应于盆腔炎症粘连、子宫内膜异位症患者
Objective: To explore how to simplify the procedure of hysterectomy, reduce the operation time and intraoperative blood loss, reduce the postoperative morbidity and shorten the postoperative hospital stay. Methods: Fifty patients with traditional abdominal hysterectomy underwent gynecological hospitalization in our hospital from August 1998 to March 1999 were randomly selected as the control group. From April to December 1999, the simplified abdominal hysterectomy Fifty patients were included in the study. Surgical use of the lower abdomen skin folds transverse incision, incision skin, blunt tearing subcutaneous tissue, fascia and peritoneum; slightly push the bladder, ring incision of cervical fascia and blunt plus sharp sharp downward separation of the main and sacral ligaments Followed down without treatment, the ring cut vaginal vault resection of the uterus; the use of imported micro-Joe absorbable synthetic lines, subcutaneous tissue and fascia merged with a continuous suture and intradermal suture of the skin, do not suture the abdominal peritoneum. The two groups treated the uterine round ligament, attachment and blood vessels the same way. Results: The operation time of the study group was reduced by 75.33min compared with that of the control group. The amount of blood loss in the study group was reduced by 130ml. The postoperative hospitalization days were shortened by about 2.1 days and the postoperative morbidity was decreased. Conclusions: Simplified abdominal fascia resection can be widely used in patients with benign gynecological lesions and some malignant lesions need to be removed, especially for pelvic inflammatory adhesions, endometriosis patients