腹腔镜下切除子宫后壁肌瘤缝合方法探讨(1)
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[摘要] 目的:探讨腹腔镜切除子宫后壁肌瘤的缝合方法,并与开腹手术进行比较。方法:选择2008年8月～2009年5月我院33例单发的子宫后壁壁间肌瘤患者,将其随机分为腹腔镜组和开腹组。其中,9例开腹手术,采用常规手术方式;24例在腹腔镜下手术,采用连续水平褥式内翻缝合法,缝合子宫肌层及浆肌层。对两组手术时间及出血量进行分析对比。结果:24例腹腔镜手术均顺利完成此种方式的缝合,平均手术时间(55±18) min (35～90 min);术中出血量(62±42) ml (10～110 ml)。9例开腹手术时间(60±9) min (45～70 min);术中出血量(64±35) ml (20～100 ml)。两组手术时间及出血量比较均无显著性差异(P>0.05)。结论:腹腔镜下子宫后壁的肌瘤切除,依靠更快捷的缝合方法,完全可以和非常成熟的开腹手术相媲美,充分体现了腹腔镜手术的优越性。
[关键词] 腹腔镜;子宫肌瘤切除术;缝合技术
[中图分类号] R737.33[文献标识码]A [文章编号]1673-7210(2010)06(c)-037-02
The discussion of laparoscopic excision of the posterior wall of the uterus myoma suture method
TANG Demin, HU Haiyan
(Department of Gynecology, Maternal and Child Health Hospital of Shenzhen City, Shenzhen 518028, China)
[Abstract] Objective: To discuss the quick suture technique of laparoscopic hysteromyoectomy in the back intramural myoma and compared with laparotomy. Methods: 33 patients with single posterior intramural uterine myoma from August 2008 to May 2009 in our hospital were divided into laparoscopic group and laparotomy group. Among them, laparoscopic hysteromyoectomy were performed in 24 patients successfully and laparotomy in 9 patients. Laparoscopic hysteromyoectomy was used Connell′s suture.The operation time and bleeding of laparoscopic hysteromyoectomy and laparotomy were compared. Results: The mean operation time was (55±18) min (35-90 min); bleeding during operation was (62±42) ml (10-110 ml) in the laparoscopic hysteromyoectomy. The mean operation time was (60±9) min (45-70 min); bleeding during operation was (64±35) ml (20-100 ml) in the laparotomy (P>0.05). Conclusion: The quick suture technique of laparoscopic hysteromyoectomy is a less invasive than laparotomy. It can advance quality of laparoscopic hysteromyoectomy.
[Key words] Laparoscopic; Hysteromyoectomy; Suture technique
腹腔镜技术在妇科手术中应用越来越广,因其微创也日益受到患者的青睐。微创的定义应该理解为创伤小、出血少、手术时间短,因此患者恢复快;但子宫后壁肌瘤的切除,因缝合难于前壁,经常腔镜手术时间长于开腹手术时间,且出血多,尤其对于初学腔镜的医生来说,难以保证真正做到微创。如果找到一种能缩短手术时间的方法,就能更好地发挥腹腔镜的作用。本文中笔者尝试采用连续水平褥式内翻缝合法,较以往的连续缝合更快捷,现总结如下供临床参考。
1 资料与方法
1.1 一般资料
选择2008年8月～2009年5月我院住院病例33例 ......
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