探讨腹腔镜下行超过孕3个月样大子宫疾病(大子宫疾病)全切术的优点、安全性及手术要点。

回顾性分析2008年6月至2015年7月山东省淄博市桓台县妇幼保健院行大子宫切除术848例患者的临床资料，其中腹腔镜手术组723例(研究组)、常规手术组125例(对照组)。

研究组723例患者中，9例(1.2%)因盆腔致密粘连手术困难而中转开腹完成，4例(0.6%，4/723)肠管损伤而镜下行修补术。切除病变子宫质量315.5～2 750.7g，平均(735.5 ± 303.7)g；手术时间86～138 min，平均(94 ± 27)min；术中出血量70～302 ml，平均(107 ± 52)ml；术后住院时间4～10 d，平均(5.5 ± 2.5)d。穿刺孔感染27例(3.7%，27/723)；术后阴道残端少量出血21例(2.9%，21/723)，行阴道填塞纱布并口服止血药物治疗后完全恢复正常。723例患者术后3、6、12个月随访，均未发现明显并发症，患者对腹壁创口满意率100%(723/723)。与对照组的子宫质量[(675.5 ± 275.7)g]和手术时间[(76 ± 34)min]比较，差异无统计学意义(P> 0.05)；术中出血量[(427 ± 146)ml]、术后住院时间[(9.0 ± 1.5)d]、术后阴道残端出血发生率(31.2%，39/125)和对腹部创口满意率(57.6%，72/125)比较，差异均有统计学意义(P< 0.05)。

腹腔镜下大子宫切除术具有出血少、术后恢复快、患者对腹部创口满意率高和术后并发症少等优势。

To evaluate the feasibility, safety, skill of surgery on laparoscopic hysterectomy of big uterine diseases.

The clinical information of laparoscopic hysterectomy of 723 cases (research group) and 125 cases (control group) of patients in total 848 cases were analyzed whose operations were carried out from Jun.2008 to Jul. 2015.

723 cases of laparoscopic surgery were successfully performed. The completion of 13 cases of pelvic extensive dense adhesions were completed with the help of scalpel and bipolar coagulation forceps, 9 cases (1.2%) under went conversion laparotomy for severe pelvic adhesion, and 4 cases (0.6%, 4/723) under went neoplasty with colonoscopy. Hysterectomy abnormal uterus weight 315.5- 2150.7 g (735.5 ± 303.7) g, and the operation time was 86- 138 min (94 ± 27) min and the blood loss was 70-302 ml (107 ± 52) ml. Moreover, the hospital stay was 4-10 days (5.5 ± 2.5) days. 27 cases (3.7%, 27/723) were suffered puncture hole infection, and 21 cases (2.9%, 21/723) of postoperative vaginal stump bleeding patients were recover back to normal after vaginal gauze packing and oral drug treatment to stop bleeding completely. 723 cases of postoperative were not found any obvious complications with 3, 6 and 12 months follow-up, respectively. 100% (723/723)of patients were satisfied with their abdominal wall wound. Statistical analysis was performed to compare the aforementioned indexes between 125 cases of random laparotomy in our hospital and this study, and there were no statistically significant differences (P> 0.05) between uterine quality [(675.5 ± 275.7) g ]and operation time [(76 ± 34) min] (P> 0.05). However, there were statistical difference in blood loss [(427 ± 146) ml, ] postoperative hospital stay [(9.0 ± 1.5) d], postoperative vaginal stump bleeding rate (31.2%, 39/125) and abdominal wounds satisfaction rate (57.6%, 72/125) (P< 0.05) between the two groups.

Laparoscopic hysterectomy of large uterus is safe and feasible. However, this require the surgeon′s experience and foundation on abdominal surgery, laparoscopic proficiency, mastery of surgical techniques, and even preoperative condition assessment. Furthermore, patients were have high satisfaction rate of the ministry of wound.