婦產科腹腔鏡手術171例臨床分析

摘 要 目的:探討腹腔鏡手術在婦產科疾病手術治療中的臨床應用價值及應用范圍，總結婦產科疾病腹腔鏡手術的臨床經驗。方法:回顧分析2004年5月～2009年8月171例行腹腔鏡手術的婦產科疾病患者的臨床資料，探討腹腔鏡手術的手術方式及并發癥。結果:患者術后住院3～12天，常規使用抗生素3～5天，留置導尿管6～24小時。2例不孕癥患者術后已足月分娩;1例闊韌帶肌瘤因質地硬、包膜界限不清、剝離過程中出血多而中轉開腹;5例切口感染，經用藥后治愈;4例皮下氣腫經處理次日消失。結論:病例選擇是腹腔鏡手術成功的關鍵。術者需經腹腔鏡技能培訓，有熟練開腹手術的經驗和高超的腹腔鏡操作水平以及手術組協調配合。腹腔鏡手術在臨床的應用將會越來越廣泛。

關鍵詞 婦產科疾病 腹腔鏡術 適應證

doi:10.3969/j.issn.1007-614x.2010.22.105

AbstractObjective:Explore laparoscopic surgery surgical treatment by obstetrical and gynecological diseases in the clinical value of universality and application.To summarize the clinical experiences of gynaecologic and obstetrics laparoscopic surgery.Method:A retrospective analysis was done in 171 patients with gynecologic and obstetrics diseases accepted laparoscopic surgery from May.2004 to Aug.2009.Discusses the ways and laparoscopic surgery complications.Results:The duration of hospitalization was 3～12d，routine antibiotics application was 3～5d，and indwelling ureter was 6～24h.1 case of broad ligament muscular tumor was converted to open surgery becaues of hard tumor，obscure boundary and bleeding.Barrenness in 4 cases，incisional infection in 5 cases，and cutaneous emphysema in 2 cases were all cured.Conclusions:Strict control of indications is the key point of laparoscopic surgery.The operator shall be well trained and have sufficient experience of open surgery as well as sophisticated level.What's more，the cooperation of the whole operation team is also important.Laparoscopic surgery in clinical applications will be more and more widely.

Key wordsGynecologic and obstetrics diseases;Laparoscopy;Indication

隨著醫學科學的進步，婦產科手術逐漸由傳統的單純開腹手術向各種微創手術方式與改良的各種陰道手術方式變化。

在變化與改革中，腹腔鏡既可綜觀盆腹腔結構與解剖關系又能擴展手術視野，提高手術部位的清晰度，使婦產科臨床醫師開闊了眼界，增強了婦產科醫師不斷探索手術技巧、大膽創新與開拓的自信心與勇氣，并導致婦產科醫師思維模式的改變。

我院從2004年5月～2009年8月為171例婦科疾病患者行腹腔鏡手術，臨床效果滿意，獲得了寶貴經驗，現報告如下。