Mage G, Wattiez A, Chapron C, Canis M, Pouly J L, Pingeon J M, Bruhat M A
Service de Gynécologie-Obstétrique, Médecine de la Reproduction, Polyclinique, CHU de Clermont-Ferrand, Université de Clermont-Ferrand I.
J Gynecol Obstet Biol Reprod (Paris). 1992;21(4):436-44.
Laparoscopic hysterectomy is a recent procedure. We present our preliminary results about 44 patients. In 77.3% of cases (34 patients) the operation was carried out completely by laparoscopy and 10 patients (22.7%) required conversion of the laparoscopy to a standard laparotomy. The indications for laparotomy were: hemostasis difficulties (6 cases); bladder injury (1 case); inability to expose the uterine pedicles and or the ureter (3 cases). Three post-operative complications occurred: one small bowel occlusion which was explored by laparoscopy, and two infection treated by antibiotics only. These preliminary results enable us: to affirm that laparoscopic hysterectomy is feasibility without an important risk of per and or post-operative complications. to specify the four situations in which laparoscopic surgery is particularly advantageous for hysterectomy: absence of genital prolapse; when uni or bilateral adnexectomy is required; previous past-history of abdomino-pelvic surgery, salpingitis, endometriosis ...; neoplastic pathologies (lymphadenectomy); to propose a laparoscopic hysterectomy classification.
腹腔镜子宫切除术是一种较新的手术方式。我们展示了44例患者的初步结果。在77.3%的病例（34例患者）中，手术完全通过腹腔镜完成，10例患者（22.7%）需要将腹腔镜手术转换为标准剖腹手术。剖腹手术的指征为：止血困难（6例）；膀胱损伤（1例）；无法暴露子宫蒂和/或输尿管（3例）。发生了3例术后并发症：1例小肠梗阻通过腹腔镜探查，2例感染仅用抗生素治疗。这些初步结果使我们能够：确认腹腔镜子宫切除术是可行的，且围手术期和术后并发症风险不大；明确腹腔镜手术在子宫切除术中特别有利的四种情况：无生殖器脱垂；需要进行单侧或双侧附件切除术时；既往有腹盆腔手术、输卵管炎、子宫内膜异位症等病史；肿瘤性病变（淋巴结清扫术）；提出腹腔镜子宫切除术的分类。
