Fanning James, Hojat Rod, Deimling Timothy
Department of Obstetrics and Gynecology, Pennsylvania State University, PA, USA.
JSLS. 2011 Oct-Dec;15(4):448-50. doi: 10.4293/108680811X13176785203833.
To review the success and morbidity of laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection.
Review of a prospective surgical database of all cases of laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection. No cases were excluded. Bowel diagnoses and procedures were total colectomy for inflammatory bowel disease (4), partial colectomy for colon cancer (6), partial small bowel resection for obstruction (1), and Whipple for pancreatic cancer (2). Two patients had 3 prior laparotomies, 8 patients had 2 prior laparotomies, and 3 patients had 1 prior laparotomy. All prior abdominal incisions were midline. Gynecologic diagnoses and procedures were laparoscopic cytoreduction for ovarian cancer (1), lsh/bso/staging for ovarian cancer (1), lavh/bso/lymphadenectomy for endometrial cancer (4), and lavh/bso, lsh/bso, or bso for large ovarian mass (7). Median patient age was 57 years, median BMI was 31kg/m(2), and all patients had medical comorbidities.
All 13 laparoscopic gynecologic surgeries were successful without trocar insertion injury, conversion to laparotomy, and without enterotomy. Abdominal adhesions were present in all cases. Median operative time was 2 hours, median blood loss was 100cc, and median hospital stay was 1 day. There were no postoperative complications.
Laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection is feasible for experienced laparoscopic surgeons.
回顾既往有剖腹肠切除术患者行腹腔镜大型妇科手术的成功率及并发症情况。
回顾性分析既往有剖腹肠切除术患者行腹腔镜大型妇科手术的所有病例的前瞻性手术数据库。无病例被排除。肠道诊断及手术包括因炎症性肠病行全结肠切除术（4例）、因结肠癌行部分结肠切除术（6例）、因肠梗阻行部分小肠切除术（1例）以及因胰腺癌行惠普尔手术（2例）。2例患者既往有3次剖腹手术史，8例患者既往有2次剖腹手术史，3例患者既往有1次剖腹手术史。所有既往腹部切口均为中线切口。妇科诊断及手术包括因卵巢癌行腹腔镜肿瘤细胞减灭术（1例）、因卵巢癌行腹腔镜下全子宫双附件切除术及分期手术（1例）、因子宫内膜癌行腹腔镜辅助阴式全子宫双附件切除术及淋巴结清扫术（4例）以及因巨大卵巢肿物行腹腔镜辅助阴式全子宫双附件切除术、腹腔镜下全子宫双附件切除术或单纯全子宫双附件切除术（7例）。患者中位年龄为57岁，中位体重指数为31kg/m²，所有患者均有内科合并症。
13例腹腔镜妇科手术均成功，无套管针插入损伤、中转开腹及肠切开情况。所有病例均存在腹部粘连。中位手术时间为2小时，中位失血量为100cc，中位住院时间为1天。无术后并发症。
对于有经验的腹腔镜外科医生而言，既往有剖腹肠切除术的患者行腹腔镜大型妇科手术是可行的。
