CAJ | 학술논문

目的：探讨腹腔镜巨大子宫切除的可行性、安全性。方法2010年1月～2013年12月对子宫超过孕3个月的巨大子宫行腹腔镜全子宫切除术，第一穿刺孔位于宫底上5 cm，手术关键步骤是恰当处理子宫血管，选择子宫动脉上行支进行电凝，分前、后、外侧切割子宫血管。结果200例均在腹腔镜下完成手术，无一例中转开腹。手术时间80～170 min，平均120 min；术中出血量20～250 ml，平均60 ml，无因术中出血致输血者。2例术后3 d发生下肢静脉血栓，抗凝治疗后痊愈。2例术后15 d阴道残端炎，阴道放置甲硝唑粉末后治愈。1例术后1个月发生阴道残端出血，缝合2针后治愈。余均无严重并发症发生。术后住院（5±2）d。144例随访6个月，阴道残端愈合良好，B超示双肾输尿管正常，盆腔未见异常。结论使用双极电凝行腹腔镜巨大子宫切除术、安全、可行。
목적：탐토복강경거대자궁절제적가행성、안전성。방법2010년1월～2013년12월대자궁초과잉3개월적거대자궁행복강경전자궁절제술，제일천자공위우궁저상5 cm，수술관건보취시흡당처리자궁혈관，선택자궁동맥상행지진행전응，분전、후、외측절할자궁혈관。결과200례균재복강경하완성수술，무일례중전개복。수술시간80～170 min，평균120 min；술중출혈량20～250 ml，평균60 ml，무인술중출혈치수혈자。2례술후3 d발생하지정맥혈전，항응치료후전유。2례술후15 d음도잔단염，음도방치갑초서분말후치유。1례술후1개월발생음도잔단출혈，봉합2침후치유。여균무엄중병발증발생。술후주원（5±2）d。144례수방6개월，음도잔단유합량호，B초시쌍신수뇨관정상，분강미견이상。결론사용쌍겁전응행복강경거대자궁절제술、안전、가행。
Objective To explore the feasibility and safety of laparoscopic resection of large uterus . Methods We performed laparoscopic hysterectomy in patients who had more than 3 months pregnant huge uterus in our hospital from January 2010 to December 2013.The mirror trocar was introduced at 5 cm above fundus .Surgical key steps were appropriate management of uterine blood vessels, electrical coagulation of the ascending uterine artery , and dissection of uterine vessels from front , rear, and lateral sides. Results The laparoscopic surgery was completed in all the 200 cases, without conversion to laparotomy .The operation time was 80-170 min,with a mean of 120 min;the blood loss was 20-250 ml,with a mean of 60 ml.No blood transfusion was required due to hemorrhage during operation .Two cases developed deep vein thrombosis at the third day after surgery , and were cured by anticoagulant therapy .Two patients with vaginal stump inflammation at 15 postoperative day were cured by applying the metronidazole powder at vaginal .One patient were sutured by 2 stitches for vaginal stump bleeding at the first month after the operation .The remaining patients had no serious complications .Postoperative hospital stay was (5 ±2) days.Follow-up reviews in 144 patients for 6 months found satisfactory heal of the vaginal stump , normal ultrasonographic results of bilateral ureters , and no abnormity in the pelvic cavity. Conclusion Laparoscopic hysterectomy of large uterus with bipolar coagulation is safe and feasible .