Köhler C, Hasenbein K, Klemm P, Tozzi R, Schneider A
Department of Obstetrics and Gynecology, Friedrich Schiller University, Bachstrasse 18, 07740 Jena, Germany.
Surg Endosc. 2003 Mar;17(3):485-90. doi: 10.1007/s00464-002-9091-4. Epub 2002 Nov 6.
Increased safety and diminished blood loss are achieved through laparoscopic-assisted vaginal hysterectomy by selective coagulation and transsection of the uterine vessels at their origin.
Three laparoscopic steps are performed: coagulation and transsection of the round ligament, of the uterine artery at its origin, and of the fallopian tube and ovarian ligament or (in BSO) the infundibulopelvic ligament. The uterine vessels are identified from the pararectal space and, following the internal liliac artery, and the ureter. Hysterectomy is completed transvaginally.
Two hundred and sixty-seven patients underwent this procedure. Mean operation time was 121 min, and hemoglobin decreased to 0.6 g/dl by postoperative day 3. It took 8.4 min on average to identify and coagulate the uterine artery.
Lateral transsection of the uterine vessels is safe and blood sparing and can be used in patients in whom blood loss must be minimized.
通过腹腔镜辅助阴式子宫切除术，在子宫血管起始处进行选择性凝血和横断，可提高安全性并减少失血。
进行三个腹腔镜步骤：圆韧带、子宫动脉起始处、输卵管和卵巢韧带（或在双侧输卵管卵巢切除术时为骨盆漏斗韧带）的凝血和横断。从直肠旁间隙、沿髂内动脉及输尿管来识别子宫血管。经阴道完成子宫切除术。
267例患者接受了该手术。平均手术时间为121分钟，术后第3天血红蛋白降至0.6g/dl。识别并凝血子宫动脉平均用时8.4分钟。
子宫血管的外侧横断安全且节省血液，可用于必须尽量减少失血的患者。
