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腹腔镜技术妇外科联合应用79例临床分析
作者：张凤格，米鑫，卢玉莲，王润，姚书忠，张寰【关键词】 腹腔镜检查；子宫切除术；阑尾切除术；卵巢囊肿剥除；胆囊切除术
［摘要］ 目的 研究腹腔镜下妇、外科联合手术（下称联合手术）完成腹腔内多种病变切除的临床效果。方法 我院2001年10月~2003年10月共完成联合手术79例，计子宫切除 胆囊切除37例；子宫切除 阑尾切除6例；卵巢囊肿剥除或附体切除 胆囊切除15例；子宫切除 胆囊切除 阑尾切除1例；卵巢囊肿剥除 阑尾切除18例；阑尾切除 盆腔脓肿引流2例。结果 79例手术均顺利，平均手术时间76min（30~120min）,平均术中出血量68ml（20~120ml）；平均肠功能恢复（术后排气）26h（10~62h）；术后平均住院时间5天（3~7天）；平均住院费用4150元。发生直肠损伤1例,镜下修补后痊愈。结论 腹腔镜下妇、外科联合手术可以切除多种病变，具有微创效果。
［关键词］ 腹腔镜检查；子宫切除术；阑尾切除术；卵巢囊肿剥除；胆囊切除术
Application of gynecological laparoscopy combined with surgical laparoscopy:an analysis of 79 cases
［Abstract］ Objective To study the clinical outcome of multi-lesions treated by gynecological laparoscopy combined with surgical laparoscopy（combined operation）.Methods From Oct.2001 to Oct.2003 in Gynecological Dept.and Sugical Dept.of Second affiliated Hospital of Scientific ＆Tecnological University,Inner Mongolia,79 cases of combined operation were performed.Among them 37 cases were hysterectomy and cholecystectomy.Sixteen cases were hysterectomy and appendectomy.Five cases were ovarian cystectomy and cholecystectomy,One case was hysterectomy,cholecystectomy and appendectomy.Eighteen cases were ovarian cystectomy and appendectomy.Two cases were pelvic abscess drainage and appendectomy.Results Operation of 79 cases were performed smoothly.The mean operating time was 75min（30~120）min.The mean bleeding was 75ml（30~120ml）.The mean postoperative recovery time of gastrointestinal function was 26 hours（10~62hours）.The mean hospitalization was 5 days and the mean expenses of hospitalization was 4150 Yuan of RMB.One case encountered injury of rectum which was repaired laparospically and cured.Conclusion Multi-lesions treated by gynecological laparoscopy combined with surgical laparoscopy are tolerable and minivasive.
［Key words］ laparoscopy；hysterectomy；appendectomy；ovarian cystectomy；cholecystectomy
由于腹腔镜技术发展迅速，手术操作日渐成熟，手术应用日趋广泛，手术效果良好［1］，使得开展腹腔镜下跨学科多脏器联合切除术成为可能。过去3年间笔者共完成腹腔镜妇科和外科联合手术（下称联合手术）79例，取得满意效果。现报告如下。
1 资料与方法
1.1 一般资料 2001年10月~2003年10月,笔者共完成联合手术79例（内蒙科技大学第二附属医院妇科和外科住院患者），其中子宫切除 胆囊切除切除37例；卵巢囊肿剥除或附件切除 胆囊切除15例；子宫切除 阑尾切除6例；子宫切除 胆囊切除 阑尾切除1例；卵巢囊肿剥除 阑尾切除18例；阑尾切除 盆腔脓肿引流2例。患者年龄20~64岁，平均41岁。44例子宫切除患者中，术前诊断为子宫肌瘤37例，子宫腺肌病5例，宫颈上皮内瘤变（CIN）Ⅲ级1例，子宫内膜原位癌1例。卵巢肿瘤33例中，卵巢浆液性囊腺瘤16例，黏液性囊腺瘤2例，卵巢巧克力囊肿9例，卵巢畸胎瘤6例。53例胆囊切除患者中44例为胆囊结石，均有临床症状，9例为胆囊息肉，术前均经B超或CT检查。27例阑尾炎均有过1次以上的急性发作史,其中23例为慢性阑尾炎，2例急性发作，2例为盆腔炎同时合并有阑尾炎。所有切除标本均经病理检查证实。
1.2 手术方式 上腹和下腹部联合手术者采用气管插管静脉复合麻醉，下腹部手术者采用连续硬膜外及腰部联合麻醉加静脉复合麻醉。CO2气腹建立后,脐上缘置10mm Trocar为第1穿刺孔。上、下腹联合手术时，选择上、下腹各2个操作孔,病变在下腹部时，下腹左右各一个操作孔。原则是：先做上腹手术，再做下腹手术，先做无菌手术，再做有菌手术。子宫切除的方法为：腹腔镜辅助阴式子宫切除（LAVH）和腹腔镜下全子宫切除（TLH）。卵巢肿瘤手术采用卵巢囊肿剥除术或附件切除术。胆囊和阑尾按常规术式。盆腔脓肿者置引流管。
2 结果
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