[1]应小燕翻译.通过腹腔镜子宫切除术（LH）和改良小切口经腹子宫切除术（MAH）切除巨大子宫的回顾性分析——子宫切除术手术路径的再评价[J].中国微创外科杂志,2011,11(4):289-294.
　Felix WongEric Lee.A Retrospective Series of Laparoscopic Hysterectomy (LH) and Modified Minilaparotomy Abdominal Hysterectomy (MAH) for the Management of Enlarged Uterus  a Reappraisal of the Surgical Approach for Hysterectomy[J].Chinese Journal of Minimally Invasive Surgery,2011,11(4):289-294.
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通过腹腔镜子宫切除术（LH）和改良小切口经腹子宫切除术（MAH）切除巨大子宫的回顾性分析——子宫切除术手术路径的再评价()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
11
期数:
2011年4期
页码:
289-294
栏目:
国外专稿
出版日期:
2011-04-20

文章信息/Info

Title:
A Retrospective Series of Laparoscopic Hysterectomy (LH) and Modified Minilaparotomy Abdominal Hysterectomy (MAH) for the Management of Enlarged Uterus  a Reappraisal of the Surgical Approach for Hysterectomy
作者:
应小燕翻译
南京医科大学第二附属医院妇产科，南京210003
Author(s):
Felix Wong①Eric Lee②
关键词:
小切口手术; 经腹子宫切除术; 腹腔镜子宫切除术; 巨大子宫; 手术路径
Keywords:
Minilaparotomy;  abdominal hysterectomy;  laparoscopic hysterectomy;  large uterus;  surgical approach
分类号:
R713.4+2
文献标志码:
A
摘要:
腹腔镜子宫切除术（laparoscopic hysterectomy，LH）自1989年引入临床，已经成为除了传统的经腹子宫切除术（abdominal hysterectomy，AH)的广泛的可以接受的另一种选择。一些随机对照试验表明LH与AH相比有它的优点，如恢复快、疼痛轻、住院时间短、近期生活质量高，而AH的优点在于手术时间短，若腹腔镜手术失败可作为一个后备的手术方案。通过对盆腔解剖有很好的了解而充分的术前评估，加之技术的成熟，作者（Felix Wong）用改良的小切口经腹子宫切除术（modified minilaparotomy approach for abdominal hysterectomy，MAH）处理巨大子宫，体会在处理有潜在较复杂的病例中MAH可能更加适宜，如非常大的子宫平滑肌瘤或子宫重量超过500 g，尤其是当LH很难操作时或LH可能导致不适当的并发症时。在2006~2008年的回顾性分析中，MAH手术具有时间短、手术后止痛剂的使用少、术后感染率低的优点，尽管与LH相比，在做巨大子宫切除术时，MAH仍存在术中出血稍增加、手术后住院时间平均延长1.5 d的缺点。MAH伤口更小，疼痛更轻。本文显示MAH治疗增大的子宫的操作技术可以安全完成，不伴有任何器官损伤，手术时间更短。因此，在行巨大子宫切除术时，MAH可以作为一种备选的手术方法。
Abstract:
Since the introduction of laparoscopic hysterectomy (LH) in 1989, it has become a widely accepted alternative to traditional abdominal hysterectomy (AH). While several randomised controlled trials showed that LH has its advantages over AH such as faster recovery, less pain, shorter hospital stay and better shortterm quality of life, AH offers a shorter operation time and remains the fallback option if the uterus cannot be removed by LH. With advancing skill and better preoperative judgment through understanding of the pelvic pathology, a modified minilaparotomy approach for abdominal hysterectomy (MAH) was used by the author (FW) to manage enlarged uterus. It was found that in potentially more complicated cases such as in the presence of very large uterine fibroids, or where the uterine weight was greater than 500 gm, the MAH approach might become useful, especially when LH is expected to be difficult to perform or to carry undue morbidity. In this retrospective personal series from 2006-2008, the author found that his MAH approach could be performed with a shorter operative time, comparable postoperative analgesic use, minimal infection, though with increased blood loss and a longer postoperative stay by an average of one and a half day when compared to LH while working on larger uterus. The MAH involves smaller wound incision and is expected to be less painful. The operative techniques of MAH as described in this paper can be performed safely without any organ injury, and shorten the operative time in the management of large uterus. Therefore, based on the findings in this paper, this technique of MAH should be considered as an acceptable alternative approach to hysterectomy for the management of large uterus.

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更新日期/Last Update: 2013-04-18