李莉莎++林琼++甘海英++温思思

[摘要]目的 探讨大子宫经腹腔镜下全切及腹腔镜联合阴道切除的手术技巧、安全性、可行性。方法 回顾性分析2015年6月～2017年4月子宫体积如12～24孕龄大小的，于我院行腹腔镜下全子宫切除及腹腔镜联合阴道子宫切除27例患者的临床资料。结果 16例患者行腹腔镜下全子宫切除术，11例患者行腹腔镜联合阴道子宫切除术。手术时间（120.0±36.5）min，术中出血量（150.3±68.2）ml，平均住院日（6.1±0.7）d。1例剖宫产史病例发生膀胱轻微副损伤，即时镜下修补，无一例发生术中或术后严重并发症。结论 选择合适的病例，具有熟练的腹腔镜手术和阴式手术基础，大子宫经腹腔镜下全切及腹腔镜联合阴道切除是安全、可行的。

[关键词]腹腔镜；腹腔镜联合阴道；子宫切除术；大子宫

[中图分类号] R713.42 [文献标识码] A [文章编号] 1674-4721（2017）09（b）-0080-03

Clinical experience of hysterectomy of enlarged uterus under laparoscopy or laparoscopy associated vaginal with 27 cases

LI Li-sha LIN Qiong GAN Hai-ying WEN Si-si

Department of Obstetrics and Gynecology，Pingxiang NO2 People′s Hospital，Jiangxi Province，Pingxiang 337055，China [Abstract]Objective To explore the operative technique，security and feasibility of hysterectomy of enlarged uterus under laparoscopy or laparoscopy associated vaginal.Methods The clinical data of 26 patients with 12-24 gestational week uterine volume from May 2015 to April 2017 were retrospectively analyzed，all patients were conducted with total laparoscopic hysterectomy or laparoscopy associated vaginal hysterectomy.Results 15 patients were completed under total laparoscopy，11 patients completed under laparoscopy associated vaginal.The operation time was （120±36.5） min，the intraoperative blood loss was （150.3±68.2） ml，the average length of hospital stay was （6.1±0.7） d.A little operative injury of bladder was made in 1 patient with history of cesarean section，repaired immediately during operation，no serious complications occurred during and after operation.Conclusion With suitable case，skilled laparoscopy operation technology and vaginal operation skills，hysterectomy of enlarged uterus under laparoscopy or laparoscopy associated vaginal is safe and feasible.

[Key words]Laparoscopy；Laparoscopy associated vaginal；Hysterectomy；Enlarged uterus

近年來随着妇科微创技术的发展，腹腔镜全子宫切除术和腹腔镜辅助经阴道切除术已经成为切除子宫手术的主流术式[1-2]，2007年以来我院开展非脱垂子宫经阴道切除或腹腔镜辅助经阴道子宫切除术广泛应用在子宫良性疾病，已经取得成熟的临床经验，过去最大子宫体积达到如孕12周，2014年6月以来逐步开展腹腔镜下全子宫切除术，随着腔镜微创技术和阴式手术技巧的成熟，2015年以来我院逐步在腹腔镜或腹腔镜联合阴道双途径下完成巨大子宫的切除（子宫大小如孕12～24周），并取得满意的手术效果，现报道如下。

1资料与方法

1.1一般资料

选择2015年6月～2017年4月于我院行腹腔镜……