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目的寻求安全、高效进行腹腔镜子宫切除术的技术方法,并比较腹膜后解剖技术游离盆腔段输尿管、子宫血管的手术效果。方法对50例患妇科良性疾病,须行腹腔镜子宫切除术者,用腹膜后解剖技术游离右侧子宫动脉、盆腔段输尿管;在直视输尿管走行的情况下电凝、横断子宫血管、子宫骶骨韧带、阔韧带前后叶和膀胱反折腹膜;用常规剖腹子宫切除术的步骤电凝、横断左侧相应的血管、韧带,前瞻性对照比较用两种不同技术方法游离暴露盆腔段输尿管、子宫血管的效果,及其后电凝、横断子宫血管、各子宫韧带的效果。结果50例腹腔镜子宫切除术均顺利完成,无并发症发生。平均手术时间102min(63~165min),腹腔镜下手术时间55分(38~76min),其中右侧盆腔腹膜后解剖平均时间21min(17~31min),加电凝、横断子宫血管、各子宫韧带时间共33min(22~39min);左侧相应手术时间20min(15~30min),P<0.05;右侧术时出血量12ml(0~20ml),左侧出血量30ml(10~40ml),P<0.05。结论腹腔镜下腹膜后解剖、游离盆腔段输尿管和子宫血管是可以通过不断训练而掌握的技术,它能彻底暴露子宫血管和子宫骶骨韧带旁的输尿管,这样,手术者能很自信地处理子宫血管和子宫骶骨韧带,有效避免输尿管的损伤,采用这一技术能使腹腔镜子宫切除术更安全、出血更少。
Objective To seek a safe and efficient laparoscopic hysterectomy technique and to compare the results of retroperitoneal dissection free pelvic ureter and uterine vascular surgery. Methods Fifty patients with benign gynecological diseases who underwent laparoscopic hysterectomy were treated with retroperitoneal dissection technique to free the right uterine artery and pelvic ureter. In the case of direct ureter, coagulation, transverse uterine vessels, uterosacral Ligaments, anterior and posterior lobes of the broad ligament, and retroperitoneal follicles. Conventional cesarean section procedures were performed to coagulate and transect the corresponding blood vessels and ligaments on the left. Prospective controls were compared by two different techniques to expose pelvic ureter and uterine vessels The effect, and after coagulation, transverse uterine blood vessels, the effect of the uterus ligaments. Results 50 cases of laparoscopic hysterectomy were successfully completed without complications. The average operation time was 102min (63 ~ 165min) and laparoscopic operation time was 55min (38 ~ 76min). The right pelvic retroperitoneal dissection average time was 21min (17 ~ 31min), plus electrocoagulation, transected uterine vessels, The time of operation was 33min (22-39min). The left operation time was 20min (15-30min), P <0.05. The right operation time was 12ml (0-20ml), the left was 30ml (10-40ml) <0.05. Conclusions Laparoscopic retroperitoneal dissection and free pelvic ureter and uterine vessels are techniques that can be mastered through constant training that thoroughly expose the uterine vessels and the ureter adjacent to the uterosacral ligament so that the surgeon can confidently treat the uterine vessels And the uterus sacral ligaments, effectively prevent ureteral injury, the use of this technique can make laparoscopic hysterectomy safer, less bleeding.