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目的 探讨膀胱预分离在腹腔镜辅助下阴式子宫切除中的优点、手术要点及临床应用价值。方法 对 12 6例因患子宫良性病变而行腹腔镜子宫切除采用改良术式为研究组 ,在术前经阴道注水预分离膀胱。随机选择原常规行腹腔镜子宫切除 12 8例为对照组。研究组 :子宫肌瘤 10 1例 ,子宫腺肌病 17例 ,子宫肌瘤合并子宫腺肌病 8例。对照组 :子宫肌瘤 87例 ,子宫腺肌病 2 1例 ,子宫肌瘤合并子宫腺肌病 2 0例。结果 两组手术均成功 ,两组手术时间、术中出血、术后疼痛强度、肛门排气时间、皮下气肿、术后病率比较 ,差异均有极显著性 (P <0 0 1) ,两组术后体温、术后恢复日常生活时间、性生活时间、性生活满意度差异无显著性( P >0 0 5 )。两组均无并发症发生。结论 腹腔镜辅助下阴式子宫切除膀胱预分离 ,摒弃了在腹腔镜下分离下推膀胱所需的繁琐操作 ,简化了手术步骤 ,使操作简单 ,容易掌握 ,且手术时间短 ,术中出血少 ,术后病率低 ,进而降低手术难度 ,提高手术效果 ,使病人治愈率提高 ,住院时间缩短 ,住院费用降低等优点 ,是一种较理想的治疗子宫良性疾病的手术方式
Objective To investigate the advantages, main points and clinical value of bladder pre-separation in laparoscopic-assisted vaginal hysterectomy. Methods One hundred and sixty-six patients with benign lesions of the uterus underwent laparoscopic hysterectomy using modified surgical procedures. The bladder was pre-transvaginal instillation before operation. Random selection of the original routine laparoscopic hysterectomy 12 8 cases as control group. Study group: uterine fibroids 101 cases, 17 cases of adenomyosis, uterine fibroids with adenomyosis in 8 cases. Control group: 87 cases of uterine fibroids, 21 cases of adenomyosis, uterine fibroids with adenomyosis 20 cases. Results The operation was successful in both groups. There was significant difference in operative time, intraoperative bleeding, postoperative pain intensity, anal exhaust time, subcutaneous emphysema and postoperative morbidity, the difference was significant (P <0.01) There were no significant differences in postoperative body temperature, postoperative daily life, sexual life and sexual life satisfaction between the two groups (P> 0.05). No complications occurred in both groups. Conclusion Laparoscopic assisted vaginal hysterectomy pre-separation of the bladder, to abandon the laparoscopic separation of the bladder to push the tedious operation, simplifying the surgical steps, the operation is simple and easy to grasp, and the operation time is short, less bleeding during surgery , Low postoperative morbidity, and then reduce the difficulty of surgery, improve the surgical effect, the patient’s cure rate, shorter hospital stay, lower hospital costs, etc., is a more ideal treatment for benign diseases of the uterus surgery