Copăescu C, Munteanu R, Iosifescu R, Ginghină O, Dragomirescu C
Clinica de Chirurgie Generală, Spitalul Clinic Sf. Ioan Bucureşti.
Chirurgia (Bucur). 2007 Mar-Apr;102(2):161-7.
Our paper presents the experience gained in nearly 12 years by the General Surgery Clinic of "Sfantul Ioan" Hospital, Bucharest in the field of laparoscopic hysterectomy. The period of time is quite long compared to the evolving of mini-invasive techniques and also unequal towards the experience of the surgeons who perform these procedure. The total number of hysterectomies was 1491 from which 251 by laparoscopic approach, the rest being made by the classic methods (most of them by laparotomy and some by vaginal approach). In the statistic we have included 15 myomectomies, 4 cases of radical hysterectomy with pelvic lymphadenectomy and 4 cases of complete hysterectomy after partial procedures made by laparotomy. The indications were represented mostly by uterine fibroma (82.07%), but also by uterine prolapse (13.14%), uterine bleeding, cervix severe dysplasia, uterine and cervix neoplasia (stage I) or associated to ovariectomy related to breast cancer. The paper analyses the results looking at the incidents and accidents (hemorrhagic, ureteral, urinary bladder or rectal lesions) and also postoperative complications (we had three reinterventions, two by laparoscopy and one by laparotomy). We also recorded one death not directly as a consequence of surgery, but as a diagnosis error. Regarding the surgical technique we initially chose the laparoscopic assisted vaginal hysterectomy. Afterwards by gaining experience we started treating the uterine pedicle and now we settled for the integral laparoscopic procedure. In our opinion laparoscopic hysterectomy represents all the advantages of mini-invasive approach. The technological development, but essentially the experience gained by surgeons are the key factors in accepting and promulgating the technique.
我们的论文介绍了布加勒斯特“圣伊万”医院普通外科诊所近12年来在腹腔镜子宫切除术领域所积累的经验。与微创技术的发展相比，这段时间相当长，而且对于实施这些手术的外科医生的经验来说也是不均衡的。子宫切除术的总数为1491例，其中251例采用腹腔镜手术，其余采用传统方法（大多数为剖腹手术，部分为经阴道手术）。在统计中，我们纳入了15例肌瘤切除术、4例根治性子宫切除术加盆腔淋巴结清扫术以及4例剖腹手术后的全子宫切除术。手术指征主要为子宫肌瘤（82.07%），但也包括子宫脱垂（13.14%）、子宫出血、宫颈重度发育异常、子宫和宫颈肿瘤（I期）或与乳腺癌相关的卵巢切除术。本文分析了手术中的意外情况（出血、输尿管、膀胱或直肠损伤）以及术后并发症（我们进行了三次再次手术，两次通过腹腔镜，一次通过剖腹手术）的结果。我们还记录了一例并非直接由手术导致的死亡，而是因诊断错误所致。关于手术技术，我们最初选择腹腔镜辅助阴道子宫切除术。后来随着经验的积累，我们开始处理子宫蒂，现在我们采用全腹腔镜手术。我们认为腹腔镜子宫切除术体现了微创方法的所有优点。技术的发展，但本质上外科医生获得的经验是接受和推广该技术的关键因素。
