论文部分内容阅读
目的探讨膀胱子宫返折处有手术瘢痕的患者在行腹腔镜下子宫或残端宫颈切除时避免膀胱损伤的方法。方法腹腔镜术中先从阴道内将宫颈牵出,在宫颈前唇膀胱下界下方环形切开筋膜,锐性或顿性分离膀胱与宫颈间的纤维连接,直达膀胱子宫腹膜返折处的瘢痕处,在此间隙内置一干纱布,将膀胱与宫颈完全分离并作为指示,再经腹腔镜作子宫或宫颈的切除。结果 16例有剖宫产史的子宫肌瘤患者和5例宫颈上皮内瘤变Ⅲ级的患者均安全地行子宫或残端宫颈切除术,未伤及膀胱。结论曾经有子宫下段剖宫产或子宫次全切除史的患者往往在膀胱子宫腹膜返折处或残端宫颈处留下瘢痕粘连,再次手术切除子宫或宫颈时,分离粘连易导致膀胱损伤,在腹腔镜下操作风险更大。我们通过经阴道内从宫颈前唇膀胱下界下方打开筋膜上推膀胱达瘢痕处,使膀胱底离开瘢痕,镜下分离就不会伤及膀胱。该方法操作简单,便于掌握,值得推广。
Objective To investigate the method of avoiding bladder injury during laparoscopic uterine or stump cervical resection in patients with surgical scar at bladder uterine fold. Methods Laparoscopic surgery in the first vaginal cervical traction in the cervix below the lower border of the bladder under the ring incision open fascia, sharp or intermittent separation of the bladder and cervical fiber connection, direct access to the bladder uterine peritoneal fold at the scar At this gap built a dry gauze, the bladder and cervix completely separated and as an indication, and then laparoscopic for uterine or cervical resection. Results 16 cases of uterine fibroids with history of cesarean section and 5 cases of cervical intraepithelial neoplasia grade Ⅲ were safely underwent hysterectomy or stump resection without injury to the bladder. Conclusions Patients with a history of cesarean section or subtotal hysterectomy of the uterus often leave scar adhesions at the peritoneal fold of the bladder uterus or at the stump. When the uterus or cervix is resected again, the adhesions can easily lead to bladder injury. Laparoscopic operation is more risky. We transplanted the bladder to the scars by opening the fascia through the vagina from beneath the bladder under the cervix and leaving the bladder at the end of the scar leaving the bladder free from microscopic detachment. The method is simple, easy to grasp, it is worth promoting.