半腹膜外子宫切除术的体会雁北地区人民医院（０３７００６）赵玉珍，卢尚礼，张淑英半腹膜外子宫切除是一种较为理想的子宫切除术。１９６１年由日本品川信良［１］首先提倡应用。近年来在国内相继开展，我院从１９９０年２月～１９９２年４月行此术６８例，均取得良好效果。资料与结果一、一般资料：本组６８例，功能性子宫出血６例，子宫壁间肌瘤３９例，粘膜下肌瘤１０例，子宫腺肌症９例，宫颈非典型增生２例，恶葡２例。年龄最小３６岁，最大６４岁。４０～５０岁５２例，占７６％。并选用同期腹膜内子宫切除５０例对照。二、手术方法：术前准备同腹膜内子宫切除，放置导尿管，行硬膜外麻醉，必要时充盈膀胱。取下腹正中或耻上弧形切口，逐层切开腹壁，分离腹直肌暴露膀胱前区。于膀胱顶部下２ｃｍ处横行切斤膀胱前筋膜，深达膀胱肌层。以食指伸入膀胱筋膜切口向两侧特别是向膀胱顶部以横扫及推离的动作进行钝性剥离，至膀胱顶部时将中脐韧带全部游离、切断缝扎。随之显露膀胱腹膜间隙，左侧入由黄色脂肪堆内开始沿膀胱向后向内向下将膀胱和腹膜逐渐分离。下推膀胱至宫颈外口下２ｃｍ。顺利地显露膀胱腹膜反折。由此中点横形剪开腹膜囊５～６ｃｍ。探查子宫及附件，将子宫挽出腹膜腔外。在于宫后 Experience of the semi-extraperitoneal hysterectomy Yanbei People’s Hospital (037006) Zhao Yuzhen, Lu Shangli, Zhang Shuying semi-extraperitoneal hysterectomy is a more ideal hysterectomy. In 1961 Shinagawa Shinagawa [1] first advocated the application. In recent years in China have been carried out in our hospital from February 1990 to April 1992 68 cases of this operation, have achieved good results. Materials and Results First, the general information: 68 cases in this group, functional uterine bleeding in 6 cases, uterine fibroids in 39 cases, 10 cases of submucosal fibroids, 9 cases of adenomyosis, 2 cases of cervical dysplasia, evil Portuguese 2 cases. The youngest 36 years old, maximum 64 years old. 40 to 50 years old in 52 cases, accounting for 76%. And choose the same period of intraperitoneal hysterectomy 50 cases of control. Second, surgical methods: preoperative preparation with intraperitoneal hysterectomy, catheterization, epidural anesthesia, filling the bladder when necessary. Remove the median or shame on the arcuate incision, abdominal incision layer by layer, separation of the rectus abdominis exposed before the area. 2cm at the top of the bladder transverse incision Jincang bladder fascia, deep bladder myometrium. With the index finger extended into the fascia incision to the sides of the bladder in particular to sweep and push off the action of blunt dissection, to the top of the bladder when all of the umbilical cord in the free, cut off the suture. Followed by revealing the peritoneal space of the bladder, the left into the yellow fat heap start along the bladder backward and inward bladder and peritoneal gradually separated. Push down the bladder to the cervix under the mouth 2cm. Smoothly revealed bladder peritoneal reflex. The midpoint of the transverse cut open the peritoneal capsule 5 ~ 6cm. Explore the uterus and attachment, the womb pulled out of the peritoneal cavity. Is behind the palace