Lloyd D, Walmsley J P, Greet T R C, Payne R J, Newton J R, Phillips T J
The Liphook Equine Hospital, Forest Mere, Liphook, Hampshire GU30 7JG.
Equine Vet J. 2007 May;39(3):210-4. doi: 10.2746/042516407x17116522.
There is little published clinical evidence on the use of a laparoscopic approach for the removal of pathologically enlarged ovaries in standing mares.
To show the orders of success and complication rates that can be expected if pathologically enlarged ovaries are removed from standing, sedated mares under laparoscopic guidance using only electrosurgical means of haemostasis.
A retrospective analysis was made of 55 mares in which the removal of an enlarged ovary was attempted by applying a standard laparoscopic procedure for routine ovariectomy in standing mares including a reliance solely on one of 2 types of electrosurgical bipolar forceps with an integrated guillotine for haemostasis and transection of the ovarian pedicle. The outcomes and complications encountered were recorded. Logistic regression analysis was performed to identify the risk of any complications associated with the size of the ovary removed and the instrument used.
In 54 of the 55 mares, the surgery was successfully accomplished by the planned approach. In one mare there was significant intraoperative haemorrhage and this necessitated the additional use of a prosthetic haemostatic device. The only other complications encountered were post operative abdominal discomfort (n = 9), delayed incisional wound healing (n = 6) and iatrogenic uterine puncture (n = 2). One mare developed a rectal tear, but not as a direct complication of the surgical procedure. None of these prevented a long-term successful outcome.
The removal of pathologically enlarged ovaries (up to 30 cm diameter) from mares under standing sedation can be accomplished predictably and safely by applying the standard laparoscopic approach that is established for routine laparoscopic ovariectomy, including a reliance solely on endoscopic electrosurgery instruments for haemostasis of the ovarian pedicle.
This study shows that the simple standing laparoscopic technique now favoured for routine ovariectomy can be used safely and reliably for the removal of pathologically enlarged ovaries. This promises to be of significant clinical advantage to mares so affected.
关于采用腹腔镜方法切除站立母马病理性肿大卵巢的临床证据鲜有发表。
展示在腹腔镜引导下，仅使用电外科止血手段，从站立、镇静的母马身上切除病理性肿大卵巢时可预期的成功率和并发症发生率。
对55匹母马进行回顾性分析，这些母马尝试通过应用标准腹腔镜程序切除肿大卵巢，该程序用于站立母马的常规卵巢切除术，包括仅依靠两种带有一体式断头台的电外科双极钳之一来止血和切断卵巢蒂。记录所遇到的结果和并发症。进行逻辑回归分析，以确定与切除卵巢大小和所用器械相关的任何并发症风险。
55匹母马中有54匹通过计划的方法成功完成手术。一匹母马术中出现大量出血，这需要额外使用人工止血装置。遇到的唯一其他并发症是术后腹部不适（n = 9）、切口愈合延迟（n = 6）和医源性子宫穿刺（n = 2）。一匹母马出现直肠撕裂，但并非手术直接并发症。这些均未妨碍长期成功结果。
通过应用为常规腹腔镜卵巢切除术建立的标准腹腔镜方法，包括仅依靠内镜电外科器械对卵巢蒂进行止血，可在站立镇静状态下可预测且安全地切除母马病理性肿大卵巢（直径达30厘米）。
本研究表明，目前常用于常规卵巢切除术的简单站立腹腔镜技术可安全可靠地用于切除病理性肿大卵巢。这有望为受此影响的母马带来显著的临床益处。
