腹腔镜外科和妇科联合手术的临床应用
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张建平

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Clinical application of combined general surgical and gynecological laparoscopy
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    摘要:

    目的:探讨腹腔镜技术在外科和妇科疾病治疗中联合应用的临床价值。
    方法:总结近7年来施行腹腔镜联合手术治疗妇、外科疾病229例的临床资料,其中腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合输卵管造口术5例,LC联合卵巢囊肿剥除术28例,LC联合子宫肌瘤剔除术25例,LC联合子宫次全切除术39例,LC联合子宫全切除术26例,LC联合子宫内膜异位症手术6例;腹腔镜阑尾切除术(laparoscopicappendectomy,LA)联合输卵管手术38例,LA联合卵巢囊肿切除术32例,LA联合子宫全切除术或子宫次全切除术24例,腹腔镜肝囊肿开窗引流术联合卵巢囊肿切除术6例。
    结果:229例妇、外科联合腹腔镜手术均获成功,无中转开腹手术。手术时间40~220 min,平均120 min;住院1~6 d,平均3.4 d。仅1例术后10 d阴道残端出血非手术疗法治愈。175例随访3~24个(平均19.5)月,1例术后2个月发现阴道残端息肉,经手术切除治愈。
    结论:严格掌握联合手术指征,充分术前准备,多科室良好配合,腹腔镜联合手术能够有效地同时处理外科和妇科并存疾病,在基层医院具有良好的应用前景。

    Abstract:

    Objective:To investigate the clinical value of combined general surgical and gynecological laparoscopy.
    Methods:During 7 years, 229 patients with abdominal and gynecological diseases were treated with laparoscopy, including laparoscopic cholecystectomy (LC)+salpingostomy in 5, LC+ovarian cystectomy in 28 cases, LC+hysteromyomectomy in 25, LC+subtotal hysterectomy in 39, LC+total hysterectomy in 26, LC+treatment of endometriosis in 6, laparoscopic appendectomy (LA)+salpingostomy in 38, LA+ovarian cystectomy in 32, LA+subtotal hysterectomy and total hysterectomy in 24, and fenestration of liver cysts+ovarian cystectomy in 6.
    Results:Laparoscopic procedures were completed in all the 229 cases without conversion to open surgery. The operation time ranged from 40 to 220 min (mean, 120 min), and postoperative hospital stay ranged from 1 to 6 days(mean 3.4 days),  only 1 patient developed vaginal stump hemorrhage 10 days after the operation and was cured by conservative therapy. Among the 229 cases, 175 were followed up for 3 to 24 months(mean 19.5 months),1 experienced polyp at vaginal stump 2 months postoperation and underwent polyp resection.
    Conclusions:Combined general surgical and gynecological laparoscopy is a promising method for patients with abdominal diseases complicated with gynecological diseases. It is important for surgeons to deeply understand the indications of laparoscopy, and get good co-operation with doctors from different departments. Patients must have adequate preoperative preparation.

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张建平, 王玮, 张虎, 蔡菊梅, 张玉芳, 郑彬, 王天忠, 张永龙.腹腔镜外科和妇科联合手术的临床应用[J].中国普通外科杂志,2009,18(9):960-963.
DOI:10.7659/j. issn.1005-6947.2009.09.019

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  • 收稿日期:2009-04-09
  • 最后修改日期:2009-08-28
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  • 在线发布日期: 2009-09-15